Inhibiting mutant isocitrate dehydrogenase 1 (mIDH-1)

ABSTRACT

Patients diagnosed with a cancer harboring an IDH-1 mutation can be treated by the administration of a therapeutically effective amount of a pharmaceutical composition comprising Compound 1, a selective inhibitor of 2-HG production from mIDH-1 enzymes including the R132 mutations R132C, R132H, R132L, R132G, and R132S.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of and priority to U.S. ProvisionalApplication No. 63/023,813, filed May 12, 2020; this application is acontinuation-in-part of International Application No. PCT/US20/33212,filed May 15, 2020; this application is a continuation-in-part of U.S.application Ser. No. 16/526,593, filed Jul. 30, 2019; and thisapplication is a continuation-in-part of U.S. application Ser. No.16/431,588, filed Jun. 4, 2019. Each of the above applications' priorityclaims, which are also part of the priority claim of this application,are described in the following paragraphs.

International Application No. PCT/US20/33212, filed May 15, 2020, claimsthe benefit of and priority to U.S. Provisional Application No.63/023,813, filed May 12, 2020; U.S. application Ser. No. 16/526,593,filed Jul. 30, 2019; U.S. application Ser. No. 16/431,588, filed Jun. 4,2019; U.S. application Ser. No. 16/414,505, filed May 16, 2019; andInternational Application No. PCT/US19/32747, filed May 16, 2019.

U.S. application Ser. No. 16/526,593, filed Jul. 30, 2019, claims thebenefit of and priority to U.S. Provisional Application No. 62/712,160,filed Jul. 30, 2018; and

-   -   is a continuation-in-part of U.S. application Ser. No.        16/431,588, filed Jun. 4, 2019, which claims the benefit of and        priority to U.S. Provisional Application No. 62/701,487, filed        Jul. 20, 2018; and U.S. Provisional Application No. 62/712,160,        filed Jul. 30, 2018; and        -   is a continuation-in-part of U.S. application Ser. No.            16/414,505, filed May 16, 2019, and International            Application No. PCT/US19/32747, filed May 16, 2019, each of            which claims the benefit of and priority to U.S. Provisional            Application No. 62/672,461, filed May 16, 2018; U.S.            Provisional Application No. 62/672,462, filed May 16, 2018;            U.S. Provisional Application No. 62/680,566, filed Jun. 4,            2018; U.S. Provisional Application No. 62/680,571, filed            Jun. 4, 2018; U.S. Provisional Application No. 62/680,560,            filed Jun. 4, 2018; U.S. Provisional Application No.            62/680,562, filed Jun. 4, 2018; U.S. Provisional Application            No. 62/692,598, filed Jun. 29, 2018; U.S. Provisional            Application No. 62/692,601, filed Jun. 29, 2018; U.S.            Provisional Application No. 62/692,604, filed Jun. 29, 2018;            U.S. Provisional Application No. 62/692,605, filed Jun. 29,            2018; U.S. Provisional Application No. 62/692,591, filed            Jun. 29, 2018; U.S. Provisional Application No. 62/773,562,            filed Nov. 30, 2018; U.S. Provisional Application No.            62/798,677, filed Jan. 30, 2019; U.S. Provisional            Application No. 62/798,681, filed Jan. 30, 2019; U.S.            Provisional Application No. 62/798,684, filed Jan. 30, 2019;            U.S. Provisional Application No. 62/798,687, filed Jan. 30,            2019; U.S. Provisional Application No. 62/798,690, filed            Jan. 30, 2019; and U.S. Provisional Application No.            62/812,367, filed Mar. 1, 2019; and        -   is a continuation-in-part of U.S. application Ser. No.            16/414,716, filed May 16, 2019, and International            Application No. PCT/US19/32742, filed May 16, 2019, each of            which claims the benefit of and priority to U.S. Provisional            Application No. 62/672,461, filed on May 16, 2018; U.S.            Provisional Application No. 62/672,462, filed on May 16,            2018; and U.S. Provisional Application No. 62/692,591, filed            on Jun. 29, 2018; and    -   is a continuation-in-part of U.S. application Ser. No.        16/414,505, filed May 16, 2019, and International Application        No. PCT/US19/32747, filed May 16, 2019, each of which claims the        benefit of and priority to U.S. Provisional Application No.        62/672,461, filed May 16, 2018; U.S. Provisional Application No.        62/672,462, filed May 16, 2018; U.S. Provisional Application No.        62/680,566, filed Jun. 4, 2018; U.S. Provisional Application No.        62/680,571, filed Jun. 4, 2018; U.S. Provisional Application No.        62/680,560, filed Jun. 4, 2018; U.S. Provisional Application No.        62/680,562, filed Jun. 4, 2018; U.S. Provisional Application No.        62/692,598, filed Jun. 29, 2018; U.S. Provisional Application        No. 62/692,601, filed Jun. 29, 2018; U.S. Provisional        Application No. 62/692,604, filed Jun. 29, 2018; U.S.        Provisional Application No. 62/692,605, filed Jun. 29, 2018;        U.S. Provisional Application No. 62/692,591, filed Jun. 29,        2018; U.S. Provisional Application No. 62/773,562, filed Nov.        30, 2018; U.S. Provisional Application No. 62/798,677, filed        Jan. 30, 2019; U.S. Provisional Application No. 62/798,681,        filed Jan. 30, 2019; U.S. Provisional Application No.        62/798,684, filed Jan. 30, 2019; U.S. Provisional Application        No. 62/798,687, filed Jan. 30, 2019; U.S. Provisional        Application No. 62/798,690, filed Jan. 30, 2019; and U.S.        Provisional Application No. 62/812,367, filed Mar. 1, 2019.

U.S. application Ser. No. 16/431,588, filed Jun. 4, 2019, claims thebenefit of and priority to U.S. Provisional Application No. 62/701,487,filed Jul. 20, 2018; and U.S. Provisional Application No. 62/712,160,filed Jul. 30, 2018; and

-   -   is a continuation-in-part of U.S. application Ser. No.        16/414,505, filed May 16, 2019, and International Application        No. PCT/US19/32747, filed May 16, 2019, each of which claims the        benefit of and priority to U.S. Provisional Application No.        62/672,461, filed May 16, 2018; U.S. Provisional Application No.        62/672,462, filed May 16, 2018; U.S. Provisional Application No.        62/680,566 filed Jun. 4, 2018; U.S. Provisional Application No.        62/680,571, filed Jun. 4, 2018; U.S. Provisional Application No.        62/680,560, filed Jun. 4, 2018; U.S. Provisional Application No.        62/680,562, filed Jun. 4, 2018; U.S. Provisional Application No.        62/692,598, filed Jun. 29, 2018; U.S. Provisional Application        No. 62/692,601, filed Jun. 29, 2018; U.S. Provisional        Application No. 62/692,604, filed Jun. 29, 2018; U.S.        Provisional Application No. 62/692,605, filed Jun. 29, 2018;        U.S. Provisional Application No. 62/692,591, filed Jun. 29,        2018, U.S. Provisional Application No. 62/773,562 filed Nov. 30,        2018; U.S. Provisional Application No. 62/798,677, filed Jan.        30, 2019; U.S. Provisional Application No. 62/798,681 filed Jan.        30, 2019; U.S. Provisional Application No. 62/798,684, filed        Jan. 30, 2019; U.S. Provisional Application No. 62/798,687,        filed Jan. 30, 2019; U.S. Provisional Application No.        62/798,690, filed Jan. 30, 2019; and U.S. Provisional        Application No. 62/812,367, filed Mar. 1, 2019; and    -   is a continuation-in-part of U.S. application Ser. No.        16/414,716, filed May 16, 2019; and International Application        No. PCT/US19/32742, filed May 16, 2019, each of which claims the        benefit of and priority to U.S. Provisional Application No.        62/672,461, filed on May 16, 2018, U.S. Provisional Application        No. 62/672,462, filed on May 16, 2018, and U.S. Provisional        Application No. 62/692,591, filed on Jun. 29, 2018.

The contents of each of the applications listed above are herebyincorporated herein by reference in their entirety.

TECHNICAL FIELD

The present disclosure relates to the treatment of cancer. Inparticular, the present disclosure provides methods of treating patientsdiagnosed with a cancer harboring certain mutant IDH-1 cancer cells.

BACKGROUND

Dysregulation of metabolism is a common phenomenon in cancer cells. TheNADP(+)-dependent isocitrate dehydrogenases 1 and 2 (IDH-1 and IDH-2)functionally modulate cellular metabolism in lipid synthesis, cellulardefense against oxidative stress, oxidative respiration, andoxygen-sensing signal transduction. The presence of mutations in IDH-1imparts a neomorphic activity to the enzyme, resulting in the productionof (R)-2-hydroxyglutarate (2-HG), the downstream effects of which causeepigenetic changes that consequently block the proper differentiation ofprogenitor cells and lead to cancer. IDH-1 mutations have been reportedin hematological malignancies, as well as many solid tumors types. Byfar the most frequent IDH-1 mutations occur at amino acid position R132,and include R132H, R132C, R132S, R132G, and R132L mutations.

Therapeutic compounds that can be useful for inhibition of mutant IDH-1and/or mutant IDH-2 cancer cells (mIDH-1 and mIDH-2) are being developedfor the treatment of certain cancers. These therapies may also reduceelevated 2-HG levels in these cancer patients. Many different smallmolecule inhibitors of mutant isocitrate dehydrogenase (mIDH) proteinswith neomorphic activity are disclosed in publications (e.g.,WO2016/044789, WO2016/044787, WO2016/044782, WO2016/171755, andWO2016/171756), including testing of these compounds in IDH-1 R132H andIDH-1 R132C enzymatic assays, and cellular 2-HG assay using HCT116mutant IDH-1 cells.

Among the other mIDH-1 inhibitors that have been developed are thosedepicted in Table 1, which includes multiple compounds that have beenreported in clinical trials, and certain other compounds that have beendescribed as being useful for the treatment of cancer.

TABLE 1

AG-120

AG-881

IDH305

IDH889

GSK321

Bay 1436032

ZX-06

ABT-199

AG-221

The FDA recently approved the administration of 500 mg once daily of amutant IDH1 inhibitor for the treatment of acute myeloid leukemia (AML)with a susceptible IDH1 mutation as detected by an FDA-approved test in(a) adult patients with newly-diagnosed AML who are ≥75 years old or whohave comorbidities that preclude use of intensive induction chemotherapyand (b) adult patients with relapsed or refractory AML. However, a 2017Multi-Discipline Review panel at the FDA noted that doubling the drugdose of this compound translates to only approximately a 40% increase inexposure, and that an increase in clearance at steady state may berelated to autoinduction. A PBPK model reasonably captured theautoinduction effect of the 500 mg QD dose of this compound on CYP3A4,and described the steady-state PK profiles of this compound in patientsat clinically relevant exposure levels. The fold-change in relativebioavailability of this compound from single-dose to steady-state forthis compound was 0.50. In addition, following administration of asingle oral dose of 50 mg/kg to rats with an intact blood-brain barrier,this compound exhibited brain penetration of 4.1% (AUC0-8 h[brain]/AUC0-8 h [plasma]).

There remains an unmet medical need for a therapeutically effectivemethod of administering a mIDH-1 inhibitor providing the followingbenefits:

-   -   i) achieving sufficient predicted free brain drug exposure        (e.g., a desirable predicted C_(brain) Ratio as disclosed        herein) suitable for treating mIDH1 solid tumors in the central        nervous system, including forms of brain cancer such as glioma;        and    -   ii) achieving and sustaining a desired steady state drug plasma        concentration within a suitable range for a patient throughout a        desired course of treatment (e.g., at least six months).

Thus, there remain particular challenges associated with treating m-IDH1forms of cancer, including the treatment of mIDH1 forms of blood cancer(e.g., AML) throughout a course of treatment (e.g., 15 days to 6months), treatment of mIDH1 forms of cancer across the blood brainbarrier (e.g., mIDH1 forms of glioma), and treatment of other mIDH1solid tumors.

There also remains a need for identifying therapeutic compounds thatselectively inhibit the production of 2-HG from mIDH-1 cancer cellsharboring R132 mutations including R132S, R132G and R132L. In addition,there remains a need for therapeutic compounds that selectively inhibitproduction of 2-HG from cancer cells harboring a variety of R132 IDH-1mutations with clinically relevant comparative potencies, whileremaining inactive at wild type IDH-1 cells. Preferably, a targeted,selective small molecule inhibitor of 2-HG production from mIDH-1 cancercells is also inactive in mIDH-2 cancer cells that produce 2-HG. Inaddition, there is a need for inhibitors of the production of 2-HG frommIDH-1 cancer cells having a R132 mutation selected from the groupconsisting of: R132L, R132G, and R132S mutation in IDH-1.

SUMMARY

The present disclosure provides methods for treating cancer. The presentdisclosure encompasses the recognition that Compound 1 is useful fortreating cancers harboring (i) an IDH1 mutation and (ii) a concurrentmutation (e.g., a mutation as described herein). Accordingly, thepresent disclosure provides methods of treating cancers harboring (i) atleast one IDH1 mutation and (ii) at least one concurrent mutation.

The present disclosure identifies a particular mIDH-1 inhibitor (i.e.,Compound 1) and, furthermore, provides therapeutic methods for usingthis compound in the treatment of cancer (e.g., AML, glioma, and varioussolid tumors). In the selection of the mIDH-1 inhibitor Compound 1, thepresent disclosure provides an insight that certain prior assessments ofmultiple mIDH-1 inhibitory compounds may have focused on and/or undulyprioritized one or more features (e.g., in vitro potency as measured inbiochemical assays for the production of 2-HG) that can lead away fromappreciation of certain unexpected properties of Compound 1 that led tothe discovery of methods of treatment as described herein.

The discovery of the methods of treatment provided herein is based inpart on the selection of Compound 1 from among many compounds reportedto inhibit the production of 2-HG from mIDH-1 cancer cells. Compound 1was not initially reported as having the greatest biochemical potencycompared to reports for certain other small molecule inhibitors ofmIDH-1. Structurally distinct compounds (e.g., AG-120, AG-881, IDH305,IDH889, GSK321, and Bay1436032) and other certain quinolinone-basedcompounds were initially reported as having greater in vitro potency inbiochemical assays measuring activity against certain mIDH-1 isoforms.Compound 1 not only inhibits 2-HG production from cells harboringvarious R132X forms of IDH-1 mutations; Compound 1 is characterized by aCNS multiparameter optimization (“CNS MPO”) value supporting furtherdevelopment as an oral therapy for mIDH-1 forms of cancer in the centralnervous system.

Compound 1 selectively inhibits production of 2-HG in mIDH-1 cancercells (i.e., cancer cells harboring IDH-1 R132X mutations) withdesirable in vitro potencies when compared to wild type IDH-1 cells andmIDH-2 cancer cells. In addition to this selectivity for mIDH-1,Compound 1 is active against multiple IDH-1 R132X mutants, and thereforecan be used to treat patients diagnosed with cancers possessing avariety of such mIDH1 mutations. Of these R132X IDH-1 mutants, R132H andR132C are the more frequently detected mutations for human mIDH-1cancers. With respect to inhibiting 2-HG production from mIDH-1 R132Cand R132H cell lines, Compound 1 shows comparable activity that iswithin 5-fold, compared to more disparate differences in activityranging from about 8-fold to 240-fold for comparative compounds (Example6).

In addition to R132H and R132C IDH-1 mutants, Compound 1 inhibits theIDH-1 mutants R132L, R132G, and R132S. Notably, Compound 1 inhibits allfive of these IDH-1 mutants (R132L, R132G, R132S, R132H, and R132C) withonly a 7-fold range in potencies. Therefore, patients diagnosed withcancer possessing mutant IDH-1, e.g., having an IDH-1 R132X mutationselected from the group consisting of: R132L, R132G, and R132S (inaddition to R132H and R132C IDH-1 mutations), can be treated withCompound 1 (see, e.g., Example 3).

The present disclosure also provides suitable dosing regimens ofCompound 1 for treating cancers harboring (i) an IDH1 mutation and (ii)a concurrent mutation. A suitable dose should possess an appropriatetherapeutic index (e.g., an observed in vivo efficacy against multipleforms of cancer harboring mIDH-1, but without unacceptable levels oftoxic side effects). More specifically, a drug plasma concentrationproviding in vivo efficacy (“Ceff”) in patients with tumors producing2-HG has been defined in the literature as one that provides >90%inhibition of 2-HG production (Fan et al., 2014). Based upon mousexenograft experiments described in Example 4 and plasma protein bindingcorrelation in humans, Compound 1 was found to have a Ceff of about1,652 ng/mL. Therefore, preferred methods of administering Compound 1 totreat a patient having a cancer harboring mIDH-1 can achieve a plasmaconcentration of at least about 1,652 ng/mL.

In addition, preferred methods of administering Compound 1 avoidunacceptably high concentrations of Compound 1 in the patient. Thediscovery of the maximum preferred concentration of Compound 1 was basedin part on the results from a 28-day oral toxicity study in monkeys(Example 10), which found that the most significant adverse event was anincrease in mean QTc interval duration, a type of cardiac event that maycause arrhythmia. The lowest Cmax plasma concentration of Compound 1 atwhich prolonged QTc interval duration was observed was about 7,840ng/mL. Accordingly, Compound 1 is preferably dosed in a manner thatachieves a drug plasma concentration of no greater than about 7,800ng/mL (“Ctox”).

Preferred methods of administering a therapeutically effective amount ofCompound 1 provide a concentration of Compound 1 in the patient bloodplasma within a therapeutic range of about 1,652-7,840 ng/mL.

The discovery of provided methods of administering Compound 1 is basedon the evaluation of multiple doses of Compound 1 (100 mg, 150 mg and300 mg) at multiple dose intervals (once daily and twice daily), both asa single agent and in combination with another therapeutic agent.Notably, the administration of Compound 1 at a total daily dose of 300mg each day (preferably, 150 mg BID) ultimately demonstrated therapeuticbenefits in patient treatment across multiple forms of mIDH1 cancer. Asdescribed in Example 11, a Phase 1/2 study of Compound 1 was initiatedto evaluate Compound 1 alone or in combination with azacitidine (“AZA”)in mIDH-1 AML/myelodysplastic syndrome (MDS) patients. The blood plasmaconcentration and other effects of administering Compound 1 wereevaluated at multiple different doses of Compound 1 at different doseintervals: 100 mg QD (i.e., 100 mg once daily), 150 mg QD (i.e., 150 mgonce daily), 300 mg QD (i.e., 300 mg once daily), and 150 mg BID (i.e.,150 mg twice daily), with Compound 1 administered both as a single agentand/or in combination with AZA. As shown in FIG. 14 and described inExample 11, as a single agent, median Cmin concentrations of Compound 1at steady-state were below Ceff in patients given doses of 100 mg or 150mg once daily. When given at a dose of 300 mg once a day, Compound 1achieved a median Cmin above Ceff, with a majority of patients reachingCeff. However, 150 mg given twice daily achieved the highest median Cminand also showed less inter-quartile variability in minimumconcentrations as compared to 150 mg once daily.

Compound 1 was also administered in combination with azacitidine (AZA).As shown in FIG. 15, in this combination, dosing a total of 150 mg ofCompound 1 once daily shows a median Cmin less than 1000 ng/mL, which iswell below Ceff. In contrast, dosing a total of 150 mg of Compound 1twice daily shows a median Cmin of over 3000 ng/mL, which is nearlytwice Ceff.

Therefore, the present disclosure provides that a total daily dose of300 mg of Compound 1, preferably administered in a divided daily dose of150 mg BID, is preferred compared to other doses and dose intervalstested. Applicant selected 300 mg total daily dose, administered as a150 mg dose form. A suitable dose can be Compound 1 administered in a300 mg dose once daily. Preferably, a suitable dose can be Compound 1administered in a 150 mg dose twice daily.

Compound 1 provides an unexpectedly durable steady state drug plasmaconcentration throughout a desired course of treatment. After theinitial 15 days of treatment with 150 mg twice daily of Compound 1, themedian steady state blood concentration of Compound 1 was maintainedabove about 2,000 ng/mL throughout a course of treatment (e.g., up toabout 36 weeks, including 12-32 weeks, as well as other intervalstherein, all measured from initial administration of Compound 1). Themedian Css was also well below the predicted threshold for QTcprolongation risk as discussed above. As shown in FIG. 18A, which showsdata for Compound 1 dosed as a single agent at 150 mg twice daily, themedian Css achieved on day 15 of cycle 1 (i.e., “C1D15, or on the 15thday of treatment with Compound 1) was maintained for at least sixfour-week treatment cycles, and in fact extended to beyond ninefour-week cycles. While concentrations are somewhat variable acrosspatients, the median Css level is maintained and does not trenddownward. Good retention of Css levels were also observed in combinationwith AZA as shown in FIG. 18B.

The discovery of the unique and remarkable properties of Compound 1 as aselective inhibitor of mIDH-1 across multiple mIDH-1 cancers led to thedevelopment of a dosing regimen of Compound 1 that overcomes therapeuticobstacles encountered with prior mIDH-1 inhibitor compounds. Through theadministration of Compound 1 at a total daily dose of 300 mg, thepresent disclosure provides sustained delivery of a mIDH-1 inhibitor ata desired drug plasma concentration for the treatment of cancer inpatients harboring mIDH-1, optionally harboring mIDH1 and a concurrentmutation.

In some embodiments, the present disclosure encompasses the recognitionthat Compound 1 is useful for treating central nervous system (CNS)cancers, such as glioma, harboring (i) an IDH1 mutation and (ii) aconcurrent mutation. IDH-1 mutations in brain cancers, such as glioma,can result in abnormal hypermethylation of histones and DNA andsuppression of normal cellular differentiation. IDH-1 R132H mutationsrepresent more than 90% of the IDH mutations present in low grade gliomaand secondary glioblastoma multiforme (GBM) patients. In addition, IDH-1mutations R132C and R132S are also reported in glioma patients. However,in order to be able to treat glioma, a small molecule inhibitor ofmIDH-1 must be able to cross the blood brain barrier (“BBB”) at atherapeutically effective concentration over time, presenting anotherchallenge to selecting a compound suitable for the treatment of glioma.

The ability to cross the BBB is by no means an intrinsic property ofmIDH-1 inhibitors. Referring to Table 11, many known mIDH-1 inhibitorshave undesirably low CNS MPO values (e.g., Table 11, compounds GSK321and Bay1436032). Therefore, even among these advanced drug candidates,there is no apparent reported correlation between mIDH-1 inhibitoryactivity and CNS MPO values.

In fact, selecting a compound that is both a potent inhibitor of mIDH-1and possesses a desirably high MPO value is not straightforward. Forexample, of the compounds specifically exemplified in WO2016/044789(“the '789 publication”), which include Compound 1, several compoundsare reported as having greater in vitro potency than Compound 1 in atleast one assay reported in Table 6 of the '789 publication (i.e.,compounds I-20, I-22, I-23, I-25, I-26, I-27, and I-29). See Table 11,which reproduces these data from the '789 publication. However, none ofthese compounds has a CNS MPO score as great as Compound 1. In fact, onecompound (1-26) does not even meet a desired minimum MPO threshold valueof 3.8 desired as a predictor of BBB permeability. Conversely, of thesix compounds with CNS MPO scores higher than Compound 1, five are lesspotent in vitro than Compound 1 in at least one biochemical assay of IDHinhibition (i.e., compounds I-2, I-3, I-5, I-6, and I-11), with onecompound being “equipotent” (compound I-1).

The lack of correlation between mIDH-1 inhibition and CNS MPO scores inTable 11 highlights the unpredictability in selecting a single mIDH-1inhibitor compound that inhibits multiple R132X forms of mIDH-1 withsufficiently similar potencies, and is also characterized by asufficiently high MPO score (e.g., 3.8 or higher), both of which aredesired in a therapy to treat a mIDH1 glioma. It is against thisbackdrop that the identification of Compound 1 as a compound having aMPO score of 3.8 or higher is unexpected. Indeed, rodent modeling showeda stark contrast between Compound 1 and two other reported mIDH-1inhibitors, AG-120 and AG-881. As described in Example 9, Compound 1partitions into the brain at a level 2-fold greater than that estimatedto achieve a therapeutic benefit, whereas AG-120 and AG-881 partitioninto the brain at a level less than what is estimated to achieve atherapeutic benefit. Thus, even when compared to another compound alsohaving a CNS MPO score suggestive of good BBB permeability, such asAG-881, these data indicate that Compound 1 possesses unexpectedlysuperior properties by combining desired comparative and selective invitro potency and predicted drug exposure in the brain.

For instance, as described in Example 9, preclinical studies show thatCompound 1 can cross the BBB in rodent models at desirable levels. Oraladministration of Compound 1 showed high systemic bioavailabilty inmultiple preclinical species. Permeability was excellent, with littleevidence of efflux, and significant brain penetration was observed inmice (98% brain binding in murine animal model). Based on theseassessments in rodents, Compound 1 is believed to cross the blood-brainbarrier to an extent effective to reach free concentration levels in thebrain consistent with pharmacological activity.

The present disclosure provides, among other things, methods of treatingcancers harboring a mutation in IDH-1 (and optionally a concurrentmutation described herein). In particular, patients diagnosed withcancer harboring a mutant IDH-1 cancer cell, e.g., having a IDH-1 R132mutation selected from the group consisting of: R132L, R132G, and R132S(in addition to R132H and R132C IDH-1 mutations), can be treated with atherapeutically effective amount of Compound 1. In some examples,patients treated with Compound 1 can have a mutant IDH-1 cancer thatdoes not have a mIDH-2 mutation detected with a FDA approved mIDH-2diagnostic (e.g., as provided at www.fda.gov/CompanionDiagnostics).

The patient can be diagnosed with a cancer (e.g., a hematologicmalignancy such as MDS or AML) characterized by the presence of a mutantallele of IDH1 (e.g., a mIDH1 selected from the group consisting of:R132L, R132G, and R132S) and a concurrent mutation selected from thegroup consisting of FLT3, NPM1, CEBPA and TP53. Preferably, the canceris not characterized by an IDH2 mutation. The patient can be treatedwith a therapeutically effective amount of Compound 1 (preferably, 150mg of Compound 1 administered twice per day, each day) throughout acourse of treatment (preferably, at least 6 months) as a single agent orin combination with another agent for treating the cancer (e.g.,azacitidine).

Compound 1 is a small molecule inhibitor of mutated forms of isocitratedehydrogenase 1 (IDH-1) enzyme. Compound 1 targets the mutant IDH-1variants R132L, R132G, and R132S at lower concentrations than thewild-type IDH-1 enzyme or mutant IDH-2 enzymes tested in vitro asdisclosed herein. Compound 1 is useful for the treatment of adultpatients diagnosed with cancer having an IDH-1 mutation as detected byan FDA-approved test. Compound 1 can be administered to patients in needthereof in a therapeutically effective amount (e.g., 150 mg orally twicedaily until disease progression or unacceptable toxicity). Patients forthe treatment of cancer with Compound 1 can be selected based on thepresence of IDH-1 mutations in the blood or bone marrow. In oneembodiment, the recommended starting dose of Compound 1 is 150 mg takenorally twice daily with or without food until disease progression orunacceptable toxicity. For patients without disease progression orunacceptable toxicity, the patient can receive the therapeuticallyeffective amount of Compound 1 for a minimum of 6 months to allow timefor clinical response.

The disclosure is based in part on the discovery that Compound 1selectively inhibits the production of 2-HG from mIDH-1 cancer cellsharboring R132 mutations including R132S, R132G and R132L withclinically relevant comparative potencies, while remaining inactive atwild type IDH-1 cells. In addition, Applicant has discovered thatCompound 1 is a targeted, selective small molecule inhibitor of 2-HGproduction from mIDH-1 cancer cells and is also inactive in mIDH-2cancer cells that produce 2-HG (e.g., Compound 1 selectively inhibitsthe production of 2-HG from mIDH-1 cancer).

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates Compound 1 binding with mIDH.

FIG. 2A and FIG. 2B are each a schematic of diaphorase-coupled assaysused in Example 1, which measure activity by the determination of thelevel of remaining co-substrate NADPH after the enzymatic reaction isquenched.

FIG. 3A is a graph showing the results from a surface plasmon resonance(SPR) biophysical characterization of the molecular interaction betweenmIDH-1 inhibitor Compound 1 and recombinant IDH-1-R132H protein.

FIG. 3B is a comparator graph showing the SPR characterization ofCompound 1 at a BCL6 control surface.

FIG. 4 consists of 4 panels: (a), (b), (c), and (d). Panel (a)illustrates free concentration of Compound 1 in plasma after three-doseoral administration (12.5, 25 and 50 mg/kg) with 12 hr dosing intervalin mouse HCT116-IDH1-R132H/+ xenograft model. Panel (b) illustrates freeconcentration of Compound 1 in tumor after three-dose oraladministration (12.5, 25 and 50 mg/kg) with 12 hr dosing interval inmouse HCT116-IDH1-R132H/+ xenograft model. Panel (c) illustrates percent2-HG inhibition in tumors in a PO dose of 12.5 mpk, 25 mpk and 50 mpk atthree different time points (4 h, 12 h, 24 h). Panel (d) illustrates invivo activity (2-HG % inhibition) of Compound 1 vs free compoundconcentration in tumor.

FIG. 5 is a synthetic reaction scheme for the preparation of Compound 1.

FIG. 6 is a graph showing plasma and brain exposure for Compound 1following 5 mg/kg PO dose in a CD-1 Mouse.

FIG. 7 is a graph showing plasma and brain exposure for Compound 1following 100 mg/kg PO dose in a CD-1 Mouse.

FIG. 8A illustrates the summary of cohorts from a phase 1 study in mIDH1AML.

FIG. 8B illustrates use of Compound 1 in a phase 2 study in mIDH1 AMLand MDS.

FIG. 9A shows clinical response of patients in a human clinical trial inmIDH1 AML who received Compound 1 monotherapy.

FIG. 9B shows clinical response of patients in a human clinical trial inmIDH1 AML who received Compound 1 and azacitidine combination therapy.

FIG. 10 shows survival of patients in a human clinical trial in mIDH1AML.

FIG. 11 illustrates frequency of baseline co-mutations in AML patientsfrom Example 11.

FIG. 12 shows time on treatment for patients in a human clinical trialfor mIDH1 MDS.

FIG. 13 illustrates frequency of baseline co-mutations in MDS patientsfrom Example 11.

FIG. 14 is a graph of the minimum blood plasma concentration (Cmin) ofCompound 1 measured in groups of human patients receiving Compound 1 asa single agent at different dose amounts and dose intervals:day 15trough (ng/mL) of Compound 1 after administration to patients of 100 QD,150 mg QD, 300 mg QD, and 150 mg BID Compound 1 as a single agent. FIG.14 also illustrates steady state is achieved by Week 2; (t1/2˜60 hrs)and 150 mg BID and 300 mg QD steady state exposures are >Ceff.

FIG. 15 is a graph of the minimum blood plasma concentration (Cmin) ofCompound 1 measured in groups of human patients receiving Compound 1 atdifferent dose amounts and dose intervals, in combination withazacitidine: day 15 trough (ng/mL) of Compound 1 after administration topatients of 150 mg QD and 150 mg BID of Compound 1 in combination withazacitidine. FIG. 15 also illustrates steady state is achieved by Week2; (t1/2 ˜60 hrs) and 150 mg BID QD steady state exposures are >Ceff.

FIG. 16 illustrates a therapeutically reduced level of 2-HG in thepatient plasma after consecutive treatment cycles of treatment withCompound 1 as a single agent.

FIG. 17 illustrates a therapeutically reduced level of 2-HG in thepatient plasma after consecutive treatment cycles of treatment withCompound 1 and azacitidine.

FIG. 18A is a graph of blood plasma concentration of Compound 1 measuredin a group of human patients treated with Compound 1 as a single agentthroughout a course of treatment. The dashed line labeled “Ceff” islower than 1652 ng/mL.

FIG. 18B is a graph of blood plasma concentration of Compound 1 measuredin a group of human pateints treated with Compound 1 and azacitidinethroughout a course of treatment. The dashed line labeled “Ceff” islower than 1652 ng/mL.

FIG. 18C is a graph of effective blood plasma concentration of Compound1 measured in a group of human patients throughout a course oftreatment.

FIG. 18D is a graph of blood plasma concentration of Compound 1 measuredin a group of human patients treated with Compound 1 and azacitidinethroughout a course of treatment. The dashed line labeled “Ceff” islower than 1652 ng/mL.

FIG. 18E is a graph of blood plasma concentration of Compound 1 measuredin a group of human patients throughout a course of treatment.

FIG. 19A is a graph of the level of 2-HG in plasma of a group of humanpatients after consecutive treatment cycles of treatment with Compound 1as a single agent.

FIG. 19B is a graph of the level of 2-HG in plasma of a group of humanpatients after consecutive treatment cycles of treatment with Compound 1and azacitidine.

FIG. 19C is a graph of the level of 2-HG in plasma of a group ofpatients after two consecutive treatment cycles.

FIG. 19D is a graph showing the reduced level of 2-HG measured over timein a group of human patients treated with 150 mg of Compound 1 BID; thePD response is sustained throughout treatment with 150 mg of Compound 1BID.

FIG. 20A is a graph showing the levels of steady-state concentration ofCompound 1 measured in a group of human patients at the day 15 trough(ng/mL) of Compound 1 after administration to patients of 150 mg QD, 300mg QD, and 150 mg BID of Compound 1. FIG. 20A also illustrates steadystate is achieved by Week 2; (t1/2˜60 hrs) and 150 mg BID steady stateexposures >IC90 and below levels are expected to increase QTcFpotential.

FIG. 20B is a graph showing the 2-HG level measured in plasma (ng/mL) ina group of human patients after administration of 150 mg QD, 300 mg QD,and 150 mg BID of Compound 1.

FIG. 20C is a graph showing the plasma 2-HG reduction observed in ahuman patient population at all doses and schedules by cycle 2, day 1 ofadministration of Compound 1 and that a preferred PD response wasobserved with 150 mg BID of Compound 1.

FIG. 21A is a graph Css over time of patients treated with Compound 1 at150 mg BID. FIG. 21A also illustrates that plasma exposures of Compound1 are stable throughout treatment duration in patients. This can serveas basis for selecting a 150 mg BID dose for dose expansion and arecommended phase II dose.

FIG. 21B is a graph plotting the ratio of steady state bloodconcentration of Compound 1 measured at different points during a Courseof Treatment in a human patient during the administration of Compound 1(150 mg BID). The Y-axis values are normalized to 1.0 using theconcentration measured on day 15 of a Course of Treatment. The data forthis graph were obtained from a single patient who received 150 mg BIDof the solid form of Compound 1 obtainable from Example 5 throughout aCourse of Treatment of over 300 days (i.e., greater than 6 months).

FIG. 22A is a graph showing the correlation between Compound 1 and 2-HGplasma levels in patients treated with Compound 1 as a single agentacross treatment groups and irrespective of time on treatment.

FIG. 22B is a graph showing the correlation between Compound 1 and 2-HGplasma levels in patients treated with Compound 1 and azacitidine incombination across treatment groups and irrespective of time ontreatment.

FIG. 23A, FIG. 23B, and FIG. 23C are graphs showing time on treatment ofAML patients treated with a single agent (Compound 1).

FIG. 24A and FIG. 24B are graphs showing time on treatment of AMLpatients treated with a combination of Compound 1 and azacitidine.

FIG. 25 is a graph showing strong correlation between ddPCR and NGS inAML patients from Example 11.

FIG. 26 is a graph showing good concordance in VAF between bone marrowanalysis (BMA) and white blood cells (WB) in AML patients from Example11.

FIG. 27A and FIG. 27B illustrate change in IDH1 VAF across categories.

FIG. 28 is a graph showing that clinical response in a treatment naïve(TN) AML patient treated with Compound 1 in combination with azacitidineis associated with decrease in 2-HG and clearance of the IDH1m clone.

FIG. 29 is a graph showing that clinical response in a R/R AML patienttreated with Compound 1 as a single agent is associated with decrease in2-HG and clearance of the IDH1m clone.

FIG. 30 is a graph showing that clinical response in MDS patientstreated with Compound 1 is associated with a decrease in 2-HG andmutation clearance.

FIG. 31 is a graph showing IDH2-mediated resistance.

FIG. 32 is a graph showing that presence of additional non-IDH1m clonesdrive resistance.

FIG. 33 shows duration of Compound 1 monotherapy treatment inpredominantly enhancing gliomas. ^(a) Patient did not have measurabledisease and was not included in efficacy analysis. *Patients stayed onstudy with PD due to clinical benefit.

FIG. 34 shows best percent change in tumor burden with Compound 1monotherapy per investigator assessment (RANO).

FIG. 35 shows percent change in tumor burden with Compound 1 monotherapyper central volumetric assessment (BCIR).

FIG. 36 illustrates frequency of baseline co-mutations in gliomapatients from Example 12.

FIG. 37 shows Compound 1 plasma concentrations in glioma patients (n=24)from a human clinical trial.

FIG. 38A shows baseline and maximum reduction plasma levels of 2-HG(after a minimum of 28 days of Compound 1 treatment) for 15disease-evaluable patients with paired samples.

FIG. 38B shows maximum percent change from baseline of 2-HG (after aminimum of 28 days of Compound 1 treatment) for 15 disease-evaluablepatients with paired samples.

FIG. 39 shows Compound 1 plasma concentrations in glioma patients (n=32)from a human clinical trial.

FIG. 40 shows duration of Compound 1 monotherapy treatment in gliomapatients from a human clinical trial. ^(a) Patient did not havemeasurable disease and was not included in response analysis. ^(b)Patient discontinued after one dose due to adverse event, wasnon-evaluable, and was not included in clinical activity analyses.

FIG. 41 shows % change from baseline in investigator assessment perRANO. ^(a) Changes >100% are shown as 100%.

FIG. 42 shows % change from baseline for central volumetric assessment(BICR). ^(a) Changes >100% are shown as 100%.

FIG. 43 shows a timeline of a patient's therapy, including exemplarybrain scans throughout the patient's treatment with Compound 1.Percentage change from baseline in tumor size as assessed by theinvestigator is given below each scan.

DEFINITIONS

As used herein, the term “Course of Treatment” refers to the time periodin which a patient is being administered an agent, including anyadministration holidays or recovery periods. A course of treatment caninclude a single treatment cycle or multiple treatment cycles.Additionally, a course of treatment can include a partial treatmentcycle. A Course of Treatment can include the total time period duringwhich a patient is on a treatment protocol for a disease, e.g. AML orMDS, with a therapy comprising the administration of a mIDH-1 inhibitorcompound.

“Next-generation sequencing or NGS or NG sequencing” as used herein,refers to any sequencing method that determines the nucleotide sequenceof either individual nucleic acid molecules (e.g., in single moleculesequencing) or clonally expanded proxies for individual nucleic acidmolecules in a high-throughput fashion (e.g., greater than 103 or moremolecules are sequenced simultaneously). Various next generationsequencing methods are known. In one embodiment, the relative abundanceof the nucleic acid species in the library can be estimated by countingthe relative number of occurrences of their cognate sequences in thedata generated by the sequencing experiment. Next generation sequencingmethods are known in the art, and are described, e.g., in Metzker, M.(2010) Nature Biotechnology Reviews 11:31-46, incorporated herein byreference. Next generation sequencing can detect a variant present inless than 5% of the nucleic acids in a sample. As shown in Example 11,for the purposes of Variant Allele Frequency analysis, digital dropletPCR (ddPCR) can also be used. ddPCR methods are known in the art, andare described in, e.g., Hindson B. J., et al. (2011). High-throughputdroplet digital PCR system for absolute quantitation of DNA copy number.Anal. Chem. 83(22): 8604-8610, and Volegstein, B., et al. (1999) DigitalPCR. Proc. Natl. Acad. Sci. USA 90: 9236-9241, incorporated herein byreference.

As used herein, the term “R132X mIDH-1 mutation(s)” refers to a mutationat the IDH-1 arginine 132 that results in inhibitory activity ofCompound 1 against the mutated IDH-1 form harboring the R132 mutation.Preferably, the R132X mutations have a 2-HG IC50 value of less than 500nM (most preferably less than 250 nM or less than 150 nM) using the invitro assay of Example 1. Accordingly, preferred R132X mutations includeR132H and R132C, as well as R132L, R132G, and R132S (or other R132Xmutations having therapeutically relevant 2-HG IC50 values obtainedusing the in vitro assay of Example 1). Patients having R132X mIDH-1mutation(s) can be identified using a suitable diagnostic, such as adiagnostic analyzing patient tissue with next generation sequencingtechnology that identified the presence of the R132X mIDH-1 mutation inthe patient tissue sample.

As used herein, the term “R132X mIDH-1 Selective Inhibitor Therapy”refers to a therapy administered to a patient to inhibit the activity ofR132X mIDH-1 in the patient, where the therapy is known to haveselective inhibitory activity against R132X mIDH-1 over wild type IDH-1.An R132X mIDH-1 selective inhibitor therapy can be administration ofCompound 1 as disclosed herein.

As used herein, “sequencing” can be Next Generation Sequencing (NGS), ahigh-throughput sequencing technology that performs thousands ormillions of sequencing reactions in parallel. Although the different NGSplatforms use varying assay chemistries, they preferably generatesequence data from a large number of sequencing reactions runsimultaneously on a large number of templates. The sequence data can becollected using a scanner, and then assembled and analyzedbioinformatically. Thus, the sequencing reactions are performed, read,assembled, and analyzed in parallel.

The terms “subject” and “patient” are used interchangeably in thepresent disclosure.

Susceptible IDH1 mutations are defined as those leading to increasedlevels of 2-hydroxyglutarate (2-HG) in the specified mIDH1 cancer cells(e.g., mIDH1 leukemia cells or mIDH1 glioma cells) and where efficacy ispredicted by 1) clinically meaningful remissions with the recommendeddose of Compound 1 and/or 2) inhibition of mutant IDH1 enzymaticactivity at concentrations of Compound 1 sustainable at the recommendeddosage according to validated methods. Susceptible mutations includeR132H and R132C mIDH1 substitution mutations. In some methods, asusceptible IDH1 mutation leads to increased levels of2-hydroxyglutarate (2-HG) in the leukemia cells. In some methods,efficacy of Compound 1 is predicted by a) clinically meaningfulremissions with the recommended dose of Compound 1 and/or b) inhibitionof mutant IDH1 enzymatic activity at concentrations of Compound 1sustainable at the recommended dosage according to validated methods.

DETAILED DESCRIPTION

Compound 1 is a small molecule mIDH-1 inhibitor useful for the treatmentof patients harboring IDH-1 mutations, in both hematologic and solidtumors. Compound 1 is also useful for treating patients harboring anIDH-1 mutation and a concurrent mutation.

Compound 1 has potent and equivalent biochemical activity against anumber of IDH-1 arginine 132 (R132) mutated forms, of which R132H andR132C are the most prevalent observed for human IDH-1. Compound 1 is asmall molecule mIDH-1 (mutated isocitrate dehydrogenase 1) inhibitor. Itis a permeable, orally bioavailable compound, with an excellentpreclinical profile in both in vitro and in vivo models.

Isocitrate dehydrogenase (IDH) is a class of enzymes that catalyze theoxidative decarboxylation of isocitrate to α-keto-glutarate (α-KG).There are three isoforms in human cells. IDH-1 resides in the cytosoland peroxisomes, whereas IDH-2 and IDH-3 are mitochondrial enzymes.IDH-1 is dimeric and uses NADP+ as an electron acceptor. IDH-3 is atetrameric enzyme and, in contrast, uses NAD+ as an electron acceptor.IDH-3 is the primary IDH enzyme participating in the Krebs cycle. Thepresence of the IDH-1 mutations imparts a neomorphic activity to theenzyme, resulting in the production of (R)-2-hydroxyglutarate (2-HG)which has been termed an “oncometabolite”, and has pleotropic roles intumorgenesis.

Since IDH-1 mutations are only found in tumor tissue, the presentdisclosure is based in part on the discovery that the selective mIDH-1inhibitor of Compound 1 can be developed as a targeted therapy formultiple mIDH-1 forms of cancer. A patient selection biomarker for theuse of Compound 1 can be the existence of IDH-1 mutation in a patientdiagnosed with a cancer harboring mIDH-1. Studies in geneticallyengineered mouse models and models derived from cancer patient samplesboth support the discovery that mIDH produces 2-HG, the downstreameffects of which cause epigenetic changes that consequently block theproper differentiation of progenitor cells and lead to cancer. Inparticular, IDH-1 mutations can lead to the loss of wild type enzymaticactivity (conversion of isocitrate to alpha-KG (α-KG)). Instead, themutated enzymes acquire the neomorphic activity of converting α-KG to2-HG. In mIDH-1 harboring cancer cells, wild type and mutant IDH-1 forma heterodimeric complex that can produce very high 2-HG levels. AllIDH-1 mutations result in the formation of the (R)-enantiomer of 2-HG,which is in contrast to the accumulation of (S)-enantiomer found inL2-HG aciduria patients, who harbor homozygous loss-of-functionmutations in 2-HG dehydrogenase. Given the structural similarity between2-HG and α-KG, 2-HG has been shown to be a competitive inhibitor of anumber of α-KG dependent histone and DNA demethylases. 2-HG inhibitsseveral KDM family histone demethylases in vitro, including H3K9/H3K36demethylases KDM4A and KDM4C, and H3K36 demethylase KDM2A. Furthermore,elevated methylation levels of H3K4, H3K9, H3K27, and H3K79 have beenobserved in mIDH-1 containing patient-derived samples, as well as incells expressing IDH mutations or treated with a cell-permeable ester of2-HG. 2-HG also inhibits the TET family of DNA demethylases, which inturn results in the hypermethylation of DNA CpG islands. Mutations inIDH-1/2 and TET2 are thus far mutually exclusive, which supports thenotion that 2-HG produced by mIDH inhibits TET2 and impairshematopoietic cell differentiation. In addition, 2-HG has also beenshown to block PHD activity, which is critical for regulation of hypoxiainducible factors and collagen hydroxylation and maturation.Hydroxylated collagen is important for the regulation of proliferationand proper differentiation of hematopoietic cells in bone marrow.Mutated IDH is also reported to block proper hepatocyte differentiationand promote cholangiocarcinoma. Since IDH-1 mutations are only found intumor tissue, the present invention is based in part on the discovery ofthat the selective mIDH-1 inhibitor of Compound 1 can be developed as atargeted therapy for cancer. The patient selection biomarker for the useof Compound 1 can be the existence of IDH-1 mutation in a patientdiagnosed with a cancer harboring mIDH-1.

Using in vitro cellular mechanistic assays monitoring levels of theerrantly overproduced, tumorigenic metabolic byproduct 2-hydroxyglutarate (2-HG), inhibition of mIDH-1 results in a >90% reduction inlevels of measured 2-HG, an effect that has also been shown to translateinto similar levels of 2-HG suppression in in vivo PK-PD studies inHCT116 (IDH-1 R132H) and HCT116 (IDH-1 R132C) xenograft bearing mice. Inboth models, the free concentration of Compound 1 was comparable inplasma and xenograft tumors, and exposures were dose dependent. At thehighest dose tested in these studies (50 mg/kg), Compound 1 inhibited2-HG levels in tumor by >90% for up to 24 hours after the last dose inthe HCT116 (IDH-1 R132H) xenograft model, and to similar levels for atleast 12 hours in the HCT116 (IDH-1 R132C) model.

Accordingly, Compound 1 is useful in methods of treating patientsdiagnosed with a cancer harboring an IDH-1 mutation. The neomorphicenzymatic activity acquired as a result of IDH-1 mutation is believed tolead to the conversion of α-ketoglutarate (alpha-KG) to2-hydroxyglutarate (2-HG). In consequence, patients bearing IDH-1mutations have elevated levels of 2-HG. Most IDH-1 mutations result in asingle amino acid change at the R132 residue, whereas most IDH-2mutations occur at either Arginine 140 (R140) or Arginine 172 (R172).The IDH mutation spectrum varies among different tumor types (Table 2).

TABLE 2 Tumor Total Mutation IDH Mutation Types Frequency IdentitiesGlioma 70-90% IDH1^(R132H), IDH1^(R132C), IDH1^(R132S), IDH2^(R172K) AML10-30% IDH2^(R140Q), IDH1^(R132H), IDH1^(R132C), IDH2^(R172K),IDH1^(R132G), IDH1^(R132S) Chondrosarcoma    75% IDH1^(R132C),IDH1^(R132H) Intrahepatic 10-25% IDH1^(R132C), IDH1^(R132L),IDH1^(R132G), Cholangio- IDH1^(R132H), IDH2^(R172W) carcinoma

For example, IDH-1 R132 mutations represent more than 90% of the IDHmutations present in low grade glioma and secondary GBM patients. IDH-1mutations have been reported in hematological malignancies such as acutemyeloid leukemia (AML) and myelodysplastic syndrome (MDS), as well asmany solid tumor types, including low grade glioma, secondaryglioblastoma, intrahepatic cholangiocarcinoma (IHCC), chondrosarcoma,and melanoma. By far the most frequent IDH-1 mutations occur at aminoacid position R132, and include R132H, R132C, R132S, R132G, and R132Lmutations. Given that Compound 1 is a potent inhibitor of a spectrum ofdifferent IDH-1 R132 mutations, but is inactive against either wild typeIDH-1 or mutated IDH-2, patients will be selected based on theoccurrence of an IDH-1 mutation at the R132 residue.

The patient can be diagnosed as having an IDH-1 R132 mutation disclosedherein using sequencing methods, such as next-generation sequencingmethods. The diagnostic patient selection method can be anext-generation sequencing (NGS)-based tumor genotyping assay analyzinga patient tissue sample such as a bone marrow sample. Useful techniquesand technologies for diagnosing a patient as having a IDH-1 R132mutation may include, without limitation, sequencing machines and/orstrategies well known in the art, such as those developed byIllumina/Solexa (the Genome Analyzer; Bennett et al. (2005)Pharmacogenomics, 6:373-20 382), by Applied Biosystems, Inc. (the SOLiDSequencer; solid.appliedbiosystems.com), by Roche (e.g., the 454 GS FLXsequencer; Margulies et al. (2005) Nature, 437:376-380), and by others.

Co-Mutations

In some embodiments, the present disclosure provides methods of treatinga patient diagnosed with a cancer characterized by (i) an IDH1 mutationand (ii) a concurrent mutation, comprising orally administering 150 mgBID (i.e., 150 mg twice daily) of Compound 1 to the patient in needthereof. In human clinical trials (e.g., as described in Example 11 andExample 12), at least one baseline concurrent mutation was detected inthe vast majority of patients. The present disclosure encompasses therecognition that, while the presence of certain co-mutations can beuseful in selecting patients for a particular treatment regimen and/orinforming cancer pathology, patients diagnosed with cancer harboringboth an IDH1 mutation and a concurrent mutation can be treated withCompound 1 without regard for the identity of the concurrent mutation,i.e., no trend in clinical response was observed in a human clinicaltrial of R/R AML patients (see Example 11).

In some embodiments, a cancer is a hematological malignancy (e.g., acutemyeloid leukemia or myelodysplastic syndrome), glioma, hepatobiliarycarcinoma, chondrosarcoma, intrahepatic cholangiocarcinoma, or a non-CNSsolid tumor. In some embodiments, a cancer is acute myeloid leukemia ormyelodysplastic syndrome. In some embodiments, a cancer is glioma.

In some embodiments, Compound 1 is administered as a single agent. Insome embodiments, Compound 1 is administered in combination with anothertherapeutic agent (e.g., azacitidine).

In some embodiments, Compound 1 is administered every day for at leastsix months.

In some embodiments, an IDH1 mutation is selected from R132C, R132H,R132G, R132S, and R132L. In some embodiments, an IDH1 mutation isselected from R132G, R132S, and R132L.

In some embodiments, a concurrent mutation is selected from CEBPA,DNMT3A, NPM1, SRSF2, NRAS, RUNX1, ASXL1, FLT3, STAG2, IDH2, TET2, SMC1A,SF3B1, U2AF1, PHF6, JAK2, MPL, NF1, ASXL2, BCOR, EED, WT1, CBL, CSF3R,ETNK1, PTPN11, ATM, TP53, EZH2, SETBP1, GATA2, CBP, CUX1, GFAP, TERT,MGMT, 1p19q, OLIG2, ATRX, PI3K3CA, CDKN2B, CDKN2A, PTEN, and NogoA. Insome embodiments, a concurrent mutation is selected from FLT3, NPM1,CEBPA, and TP53. In some embodiments, a concurrent mutation is selectedfrom DNMT3A, NPM1, SRSF2, NRAS, RUNX1, ASXL1, FLT3, STAG2, TET2, SMC1A,SF3B1, U2AF1, PHF6, JAK2, MPL, NF1, ASXL2, BCOR, EED, WT1, CBL, CSF3R,ETNK1, PTPN11, ATM, and TP53. In some embodiments, a concurrent mutationis selected from CEBPA, DNMT3A, NPM1, SRSF2, NRAS, RUNX1, ASXL1, FLT3,STAG2, TET2, SMC1A, SF3B1, U2AF1, PHF6, JAK2, MPL, NF1, ASXL2, BCOR,EED, WT1, CBL, CSF3R, ETNK1, PTPN11, ATM, and TP53. In some embodiments,a concurrent mutation is selected from NPM1, SRSF2, RUNX1, ASXL1, STAG2,TET2, SMC1A, SF3B1, U2AF1, PHF6, JAK2, MPL, NF1, ASXL2, EED, WT1, CBL,CSF3R, ETNK1, PTPN11, ATM and TP53.

In some embodiments, a concurrent mutation is selected from SRSF2,ASXL1, RUNX1, DNMT3A, CSF3R, NPM1, STAG2, EZH2, U2AF1, SETBP1, NRAS,FLT3, GATA2, TP53, CBP, and CUX1. In some embodiments, a concurrentmutation is selected from SRSF2, ASXL1, RUNX1, DNMT3A, CSF3R, NPM1,STAG2, U2AF1, NRAS, FLT3, and TP53.

In some embodiments, a concurrent mutation is selected from TP53, GFAP,TERT, MGMT, 1p19q, OLIG2, ATRX, PI3K3CA, CDKN2B, CDKN2A, PTEN, NogoA,and DNMT3A. In some embodiments, a concurrent mutation is selected fromTP53 and DNMT3A. In some embodiments, a concurrent mutation is selectedfrom TP53, ATM, and NRAS. In some embodiments, a concurrent mutation isselected from DNMT3A, TP53, ATM, and NRAS.

In some embodiments, a concurrent mutation is not FLT3. In someembodiments, a concurrent mutation is not FLT3, CEBPA, BCOR, KRAS, NRAS,BCORL1, or DNMT3A. In some embodiments, a concurrent mutation is notIDH2.

In some methods, a therapeutically effective amount of Compound 1 can beadministered to a patient having a mIDH1 mutation at R-132 and aconcurrent mutation at FLT3. The FMS-like tyrosine kinase 3 (FLT3) geneencodes a membrane bound receptor tyrosine kinase that affectshematopoiesis leading to hematological disorders and malignancies. FLT3is one of the frequently mutated genes in hematological malignancies,such as adult acute myeloid leukemias (AML). The presence of a FLT3internal tandem duplication has been detected in patients with acutemyeloid leukemia (AML) and patients diagnosed with intermediate and highrisk myelodysplastic syndrome (MDS). The heightened frequency ofconstitutively activated mutant FLT3 in adult AML has made the FLT3 genea highly attractive drug target in this tumor type. A method fortreating a FLT3 mutated mIDH1 proliferative disorder can compriseidentifying a mIDH1 R132 mutation in a patient and measuring expressionof a mutated FLT3 or a constitutively active FLT3 mutant, and one ormore genetic abnormalities in a sample obtained from a tumor sampleobtained from the patient; and administering to the patient atherapeutically effective amount of Compound 1 or a pharmaceuticallyacceptable salt thereof (e.g., 150 mg Compound 1 BID) for 6 months ormore. Useful techniques and technologies for diagnosing a patient ashaving a IDH-1 R132 mutation may include, without limitation, sequencingmachines and/or strategies well known in the art, such as thosedeveloped by Novartis (e.g. LeukoStrat® CDx FLT3(www.accessdata.fda.gov/cdrh_docs/pdf16/p160040c.pdf)).

A method of treating a patient with acute myeloid leukemia (AML), cancomprise: (a) analyzing a genetic sample isolated from the patient forthe presence of cytogenetic abnormalities and a mutation in at least oneof FLT3, NPM1, CEBPA, IDH1, and TP53 genes; and (b) treating the patientby administering a therapeutically effective amount of Compound 1 to thepatient (e.g., a total of 150 mg of Compound 1 BID each day) if themutation is present in R132 mIDH1 and at least one of FLT3, NPM1, CEBPAand TP53 genes.

Compound 1 can be administered as a single agent as the R132X mIDH-1Selective Inhibitor Therapy, or in combination with other therapeuticagents that are not mIDH-1 inhibitors as a combination for the R132XmIDH-1 Selective Inhibitor Therapy. As used herein, the term “R132XmIDH-1 mutation(s)” refers to a mutation at the IDH-1 arginine 132 thatresults in inhibitory activity of Compound 1 against the mutated IDH-1form harboring the R132 mutation.

In some methods, Compound 1 is administered to a patient diagnosed ashaving a R132 IDH1 mutation either as a single agent or in combinationwith azacitidine. In some examples, patients have been treated with orare already being treated with azacitidine. In some embodiments, acombination therapy of Compound 1 and azacitidine can be administeredfor the treatment of patients with a cancer harboring aIDH-1 mutation(e.g., mIDH1 forms of AML). For example, patients can be administeredCompound 1 daily (BID) in continuous 28-day cycles, in combination withazacitidine (administered at the dose of 75 mg/m² for 7 days IV/SC perevery 28-day cycle).

Achieving Effective Blood Plasma Concentration of Compound 1

The present disclosure provides methods for the treatment of cancer(e.g., AML or MDS or glioma) comprising a step of administering to asubject a therapeutically effective amount of a pharmaceuticallyacceptable form of Compound 1. In some examples, the pharmaceuticallyacceptable form of Compound 1 is an oral dosage form (e.g., as providedin Example 5) administered to the patient as R132X mIDH-1 SelectiveInhibitor Therapy consisting of the oral administration of an oraldosage form of Compound 1 administered either as a single agentinhibitor of mIDH-1, or in combination with azacitidine or cytarabine.When Compound 1 is administered in such combination therapy, the subjectcan be receiving or have previously received treatment with azacitidineor cytarabine.

Post-therapy, 2-HG plasma levels less than 180 ng/mL are associated withbetter overall and disease-free survival in patients with IDH-1 andIDH-2 mutated AML (JANIN, M. et al., Serum 2-Hydroxyglutarate Productionin IDH1- and IDH2-Mutated De Novo Acute Myeloid Leukemia: A Study by theAcute Leukemia French Association Group, Journal of Clinical Oncology,32(4): 297-305 (2014)). FIG. 16 shows that 150 mg once daily dosingachieved a median 2-HG plasma concentration above 600 ng/mL. Meanwhile,300 mg once daily achieved a median 2-HG plasma concentration slightlyabove 200 ng/mL, and 150 mg twice daily achieved a median 2-HG plasmaconcentration of approximately 100 ng/mL. This demonstrates the abilityof 150 mg twice daily dosing to lower 2-HG levels below a literatureestablished level as compared to 150 mg and 300 mg once daily.

The disclosure is based in part on the discovery that oraladministration of Compound 1 (e.g., in the pharmaceutically acceptableoral dosage form resulting from the preparation method of Example 5) tohumans having elevated blood 2-HG levels (i.e., above about 180 ng/mL)can provide a steady state (trough) blood concentration above atherapeutically effective amount of Compound 1 (e.g., above the IC90concentration for R132H and/or R132C mIDH-1, and/or concentrations ofgreater than about 2,000 ng/mL or concentrations of greater than about1652 ng/mL) throughout a course of treatment of 6 months from theinitial administration of Compound 1, while simultaneously reducing andthen maintaining the levels of 2-HG to below 200 ng/mL within about 15days of daily treatment with Compound 1. Alternatively, the levels of2-HG are maintained below 180 ng/mL within about 15 days of dailytreatment with Compound 1. In these observations, Compound 1 wasadministered in an oral dosage form (obtainable from the method inExample 5) twice per day (150 mg BID) to AML or MDS adult patientsharboring a R132X IDH-1 mutation. After the initial 15 days of treatmentwith 150 mg BID of this oral dosage form of Compound 1, the steady state(trough) blood concentration of Compound 1 (pre-dose) was maintainedabove about 2,000 ng/mL (and well below the predicted threshold for QTcrisk) throughout a course of treatment (e.g., up to about 30 weeks,including 12-30 weeks, and 20 weeks as well as other intervals therein,all measured from initial administration of Compound 1).

Accordingly, the present disclosure provides methods of treatingpatients harboring isocitrate dehydrogenase 1 mutations (mIDH-1)(preferably including one or more R132X mIDH-1) diagnosed with AML orMDS. The method can comprise administering to the patient in needthereof a therapeutically effective amount of a R132X mIDH-1 SelectiveInhibitor Therapy. The R132X mIDH-1 selective inhibitor can consist ofCompound 1 as the only R132X mIDH-1 inhibitor compound administered tothe patient (e.g., in an oral dosage form such as the solid formobtained from Example 5). Compound 1 can be administered to a patientharboring the R132X mIDH-1 identified in a tissue sample, and/or anelevated 2-HG blood concentration (e.g., above about 180 ng/mL) for acourse of treatment of at least three consecutive treatment cycles of 28consecutive days of administration for each cycle. The course oftreatment can start with the initial administration of Compound 1 in thefirst of the at least three or more consecutive 28-day treatment cycles.The administration of the therapeutically effective amount of Compound 1throughout a course of treatment (e.g., at least 15 consecutive days,preferably up to 30 weeks or more) to a patient having elevated 2-HGlevels (e.g., 2-HG blood concentrations in plasma of 200-10,000 ng/mL)can result in a therapeutic effect on the patient evidenced by a durabletherapeutically effective trough blood plasma concentration of Compound1 in the patient throughout the course of treatment (e.g., above theIC90 concentration for R132H and/or R132C mIDH-1, and/or concentrationsof greater than about 2,000 ng/mL and less than about 7,200 ng/mL, orabove the IC90 concentration for R132H and/or R132C mIDH-1, and/orconcentrations of greater than about 1652 ng/mL and less than about7,840 ng/mL).

Compound 1 can be administered at a dose of 150 mg twice per daythroughout the course of treatment. Compound 1 can be administered withfood to improve bioavailability of Compound 1. The course of treatmentcan be at least 15 consecutive days starting with the initial dose ofCompound 1 and longer (e.g., up to 30 weeks, 15 days to 30 weeks, 15days to 12 weeks, at least 12 weeks, 12-30 weeks, 15 days to 6 monthsand other intermediate or longer durations or intervals apparent basedon the present disclosure).

Some methods further comprise the administration of azacitidine to thepatient throughout the course of treatment. Azacitidine can besubcutaneously or intravenously administered to the patient in anazacitidine treatment cycle consisting of the administration of a totaldose of 75 mg/m² each day for 7 consecutive days beginning at the startof each treatment cycle, followed by 21 consecutive days withoutadministration of the azacitidine to the patient. A 48-hourdose-interruption of azacitidine is allowed for weekends or holidays. Ifno response is seen after 2 treatment cycles, azacitidine can beadministered at a total dose of 100 mg/m² each day. Treatment with IDH1minhibitor and azacitidine showed synergistic effects on releasingdifferentiation block in mIDH leukemia models in vitro.

The methods can further comprise the administration of cytarabine to thepatient throughout the course of treatment. Cytarabine can besubcutaneously or intravenously administered to the patient in acytarabine treatment cycle consisting of administration of a total doseof 20 mg/day each day for 7 consecutive days beginning at the start ofeach treatment cycle, followed by 10 consecutive days withoutadministration of cytarabine to the patient. Cytarabine can also beadministered 20 mg BID subcutaneously for 10 days beginning at the startof each treatment cycle. In the induction therapy of AML, the cytarabinedose administered in combination with other anticancer drugs can be 100mg/m²/day by continuous IV infusion (Days 1 to 7) or 100 mg/m² IV every12 hours (Days 1 to 7). Cytarabine injection can be used intrathecallyin acute leukemia in doses ranging from 5 mg/m² to 75 mg/m² of bodysurface area. The frequency of administration can vary from once a dayfor 4 days to once every 4 days. The dose can be 30 mg/m² every 4 daysuntil cerebrospinal fluid findings are normal, followed by oneadditional treatment.

A patient can be identified as having a R132X mutation in mIDH-1 using adiagnostic method comprising a sequencing analysis (e.g., nextgeneration sequencing (NGS)) of bone marrow or other tissue sampleobtained from the patient prior to the administration of Compound 1 tothe patient. The R132X gene mutation can be determined prior toadministration of Compound 1 to the patient. Compound 1 can beadministered to patients who have received prior anticancer therapyand/or other concomitant (non-anticancer) medications. In some examples,Compound 1 is administered to patient who has not received a priormIDH-1 inhibitor therapy.

As provided herein, methods for the administration of an inhibitor ofthe R132X mutant IDH-1 (mIDH-1 Inhibitor) Compound 1 provide anunexpectedly durable steady state blood concentration of the mIDH-1Inhibitor throughout a desired course of treatment. For example,therapeutic methods provided herein can provide AML or MDS patientsharboring a R132X mIDH-1 mutation with durable steady state bloodconcentrations of the mIDH-1 Inhibitor of Compound 1 at atherapeutically effective level (e.g., above the IC90 concentration fora R312X mIDH-1) without a substantial decline (e.g., no more than 10%reduction) in initial Compound 1 mIDH-1 Inhibitor steady state bloodconcentration (e.g., blood concentration measured about 12 hours afteran initial dose of the mIDH-1 Inhibitor) over a course of treatment ofgreater than about 12 consecutive weeks (e.g., 3 consecutive 28-daytreatment cycles and preferably at least about 6 months). In addition,the mIDH-1 Inhibitor Compound 1 can be administered to AML or MDSpatients harboring a R132X mIDH-1 mutation in a therapeuticallyeffective manner that provides for the reduction of elevated 2-HG levelswithin about 15 days of initiating a course of treatment, preferablyachieving and maintaining 2-HG levels in these patients at a level at orbelow about 180 ng/mL starting by day 15 in a course of treatment andcontinuing throughout a course of treatment lasting for at least 12weeks or longer (e.g, 12-30 weeks).

Referring to FIGS. 18A-18E, the administration of Compound 1 in the oraldosage form described in Example 5 at 150 mg BID resulted in a sustainedtherapeutically effective trough blood plasma concentration above 2,000ng/mL after cycle 3 of a 28-day treatment cycle. Simultaneously,referring to FIGS. 19A-19D, the administration of Compound 1 in the oraldosage form from Example 5 at 150 mg BID resulted in a sustained 2-HGlevel (e.g., under 200 ng/mL in plasma after cycle 3 day 1 of a 28-daytreatment cycle). This effect is in contrast to other IDH1 inhibitorsthat have been advanced clinically. Accordingly, the invention is alsobased in part on the discovery that administration of Compound 1 at 150mg BID results in a sustained ratio of greater than about 10 (preferablygreater than about 20) of blood plasma concentration of Compound 1(e.g., trough concentrations measured pre-dose at concentrations ofabout 2,000 ng/mL or greater) to 2-HG blood level (e.g, plasmaconcentrations of about 200 ng/mL or lower, including concentrations ofabout 100 ng/mL) after cycle 3 day 1 (i.e., after BID doses administeredover the initial 15 consecutive days of treatment) of a 28-day treatmentcycle. A plasma half-life of about 60 hours was estimated for Compound1, with steady state achieved by week 2 of the course of treatment. Thesteady state blood concentrations of Compound 1 measured in the patientswas above the IC90 value for 2-HG inhibition in R132X mIDH-1 cells(described in the Examples). As shown in FIGS. 18A-18E, the plasmaexposures (steady state blood plasma concentration) of Compound 1 weredurable (i.e., sustained) throughout the 30-week treatment duration. Asshown in FIGS. 19A-19D the plasma 2-HG concentrations were reduced tothe normal range within 1 cycle (C2D1) and maintained throughout thetreatment duration. No dose limiting toxicities of Compound 1 wereobserved during dose escalation studies, and the maximum tolerated dose(MTD) of Compound 1 was not reached. FIGS. 18A-18E are graphs of thedata obtained from measuring the steady state concentrations frompatients in the clinical trial receiving a 150 mg BID dose of Compound1, either as a single agent or in combination with azacitidine asdescribed in Example 11. As shown in FIG. 18D, azacitidine did not alterthe pharmacokinetics of Compound 1, with consistent Compound 1 plasmaconcentrations observed over the treatment duration. FIG. 21A is a graphshowing the steady state concentration of Compound 1 measured inpatients at various points during the Course of Treatment described inthe clinical trial of Example 11, with each point representing a cyclenumber and day number (each cycle is 28 consecutive days ofadministration of 150 mg BID Compound 1). The steady state concentrationof Compound 1 remained above the minimum desired level (bottom dashedline) and the maximum desired level (upper dashed line). FIG. 21B is agraph plotting the ratio of steady state blood concentration of Compound1 measured at different points during a Course of Treatment in a humanpatient during the administration of Compound 1 (150 mg BID). The Y-axisvalues are normalized to 1.0 using the concentration measured on day 15of a Course of Treatment. The data for this graph were obtained from asingle patient who received 150 mg BID of the solid form of Compound 1obtainable from Example 5 throughout a Course of Treatment of over 300days (i.e., greater than 6 months).

Compound 1, with a plasma half-life of ˜60 hours, achieved steady-stateconcentration within 2 weeks of dosing and remained consistent overtreatment duration. At 150 mg BID (RP2D) as a single agent, steady-stateplasma concentrations are above the preclinical Ceff resulting in ≥90%reduction in plasma 2-HG and below Compound 1 levels predicted, in NHP,to pose a QTc prolongation risk. At 150 mg BID as a single agent, asignificant reduction (p<0.0009) in plasma 2-HG levels was achieved byend of Cycle 1 and was sustained over the treatment duration.Combination therapy of azacitidine plus Compound 1 150 mg BID achievedsteady state concentrations of Compound 1 above the preclinical Ceff,resulting in ≥90% reduction in plasma 2-HG and below Compound 1 levelspredicted to pose a QTc prolongation risk. A significant (p<0.0001)reduction in plasma 2-HG levels at the end of Cycle 1 was observed withthe combination of Compound 1 (150 mg BID) and azacitidine and wassustained over the treatment duration. However, a slower rate of declinecompared to the single agent Compound 1 has been observed.

The PK/PD relationship of individual subjects' plasma Compound 1 and2-HG concentration across single agent treatment groups and irrespectiveof time on treatment is presented in FIG. 22A. Compound 1 concentrations<1,000 ng/mL correspond to early time point assessments (C1D0-C1D15). Nocorrelation of exposure to 2-HG reduction is observed until Compound 1concentrations crossed the Ceff predicted by in vivo models to resultin >90% reduction in plasma 2-HG levels. As shown in FIG. 22B, nocorrelation of exposure to 2-HG reduction is observed until Compound 1concentrations crossed the Ceff predicted by in vivo models to resultin >90% reduction in plasma 2-HG levels. Maximum, most consistentexposure-response was observed at the median Css of Compound 1 with 150mg BID (RP2D).

The PK/PD relationship of individual subjects' plasma Compound 1 and2-HG concentration across combination of Compound 1 and azacitidinetreatment groups and irrespective of time on treatment is presented inFIG. 22B. Compound 1 concentrations <1,000 ng/mL correspond to earlytime point assessments (C1D0-C1D15). No correlation of exposure to 2-HGreduction is observed until Compound 1 concentrations crossed the Ceffpredicted by in vivo models to result in >90% reduction in plasma 2-HGlevels. Maximum, most consistent exposure-response was observed at themedian Css of Compound 1 with 150 mg BID (RP2D).

FIGS. 23A and 23C are graphs showing the results from the clinical trialin Example 11, showing the 150 mg BID administration Compound 1 (solidform obtainable from Example 5) was administered as a single agent tomultiple patients over a Course of Treatment with times having a medianof 94 days, and a range of 1 to 586 days. About 32% of the patientsremain on treatment.

FIG. 23B depicts responses for relapsed or refractory (R/R) AMLpatients, and shows prolonged duration of treatment with Compound 1 wasobserved with a first response occurring within 2 months of treatmentwith Compound 1. Responses <CR/CRi were noted to deepen with continuedtreatment resulting in CR/CRh/CRi rate of 41% in R/R AML. Clinicalbenefit (SD ≥8 weeks) was observed in subjects without an IWG definedresponse. 10% of patients (1 AML and 2 MDS) remained on treatment.Treatment Discontinuation: Progressive Disease (PD) (9), death (6),transplant (4), Adverse Events (AE) (3), investigator's decision (2),withdrawal of consent (1), and lack of response (3).

Administration of Compound 1 at 150 mg BID in the clinical trial ofExample 11 reduced the measured levels of 2-HG in the blood of patientsas shown in FIGS. 19A-19D and FIGS. 20B-20C. The 2-HG levels measured inthe blood of patients during this clinical trial of Example 11 are shownin FIGS. 19A-19D, demonstrating reduction of 2-HG levels within about1-2 28-day treatment cycles (150 mg Compound 1 is administered BID oneach day for 28 consecutive days for each treatment cycle, as describedin Example 11).

FIGS. 20B-20C are each a graph showing the concentration of 2-HGmeasured in the blood of patients receiving one of three different dosesand dose intervals: 150 mg QD, 300 mg QD, or 150 mg BID (eitherreceiving Compound 1 as a single agent or in combination withazacitidine as described in the clinical trial of Example 11, in eachcategory). The 2-HG levels are measured prior to administration ofCompound 1, and then measured after administration of Compound 1 up tocycle 2, day 1 after first receiving Compound 1 (as the solid formobtained from Example 5).

This disclosure is based in part on the discovery that administration ofCompound 1 at 150 mg BID resulted in a higher blood exposure level thaneither 150 mg QD or 300 mg BID at day 15. See, for example, FIG. 20A.Administration of Compound 1 at 150 mg QD BID resulted in a bloodexposure level of <3000 ng/mL at day 15. Administration of Compound 1 at300 mg QD BID did not result in improved blood levels at day 15. Incontrast, administration of Compound 1 at 150 mg BID results in a bloodexposure level of >3000 ng/mL at day 15. Additionally, the invention isbased in part on the discovery that administration of Compound 1 at 150mg BID resulted in a lower 2-HG level in plasma than either 150 mg QD or300 mg BID at day 15. See, for example, FIG. 20B.

The oral dosage form of Compound 1 (Example 5) was administered to humanpatients as a single agent (150 mg QD, 300 mg QD, 150 mg BID and 100 mgQD until disease progression) in a human clinical trial treating AML/MDSin cancer patients harboring a mIDH1 mutation, as described in theExamples below. FIG. 20A is a graph showing the concentration ofCompound 1 measured in the blood of patients after receiving Compound 1(as the solid form obtained from Example 5) in one of three differentdose and dose intervals: 150 mg QD, 300 mg QD or 150 mg BID (eitherreceiving Compound 1 as a single agent or in combination withazacitidine as described in the clinical trial of Example 11, in eachcategory).

The present disclosure includes methods for treating AML or MDS inpatients having one or more R132X mIDH-1 mutations (e.g., as measured ina tissue sample obtained from the patient) and/or elevated 2-HG levels(e.g., 2-HG levels measured in a blood sample at above about 180 ng/mL),comprising administration of Compound 1 alone (e.g., as a single agent)or in combination with azacitidine or cytarabine. For methods whereCompound 1 is administered as a combination, the subject beingadministered Compound 1 may be receiving or previously receivedtreatment with azacitidine or cytarabine.

The methods of treatment can include the administration of Compound 1such that on day 1 of cycle 4 of repeated 28-day treatment cycles (orday 1 of any subsequent cycle), the trough blood plasma concentration ofCompound 1 has not decreased more than about 5-25%, about 5-20%, about5-15%, about 5-10%, about 10-25%, about 10-20%, or about 10-15%, ascompared to the trough blood plasma concentration on day 1 of cycle 2.Preferably, patients harboring a R132X mDH-1 mutation can beadministered 150 mg of Compound 1 twice daily (BID) every day onconsecutive days (without holiday) for one or more continuous 28-daycycles.

Compound 1 can be administered to certain patients in combination with ahypomethylating agent such as azacitidine. IDH1 mutations (e.g., in AMLor MDS patients harboring a R132X mDH-1 mutation) can result in abnormalhypermethylation of histones and DNA and suppression of normal cellulardifferentiation. The combination of Compound 1 and azacitidine can beadministered for the treatment of patients with AML harboring IDH1mutations. For example, patients can be administered the Compound 1daily (BID) in continuous 28-day cycles, alone or in combination withazacitidine (administered at the dose of 75 mg/m² for 7 days IV/SC perevery 28-day cycle). For example, Compound 1 can be administered at adose of 150 mg QD or 150 mg BID in combination with azacitidine(azacitidine administered per standard of care for a patient). FIG. 24Ais a graph showing the results from the clinical trial in Example 11,showing the 150 mg BID administration Compound 1 (solid form obtainablefrom Example 5) in combination with the administration of azacitidine(administered at the dose of 75 mg/m² for 7 days IV/SC per every 28-daycycle), administered to multiple patients over a Course of Treatmentwith times having a median of 87 days, and a range of 10 to 351 days.About 48% of the patients remain on treatment.

As shown in FIG. 24B, upon further duration of treatment, clinicalresponses observed in R/R or TN AML and MDS: cytopenias associated withazacitidine may influence depth of IWG response. An ORR of 46% wasobserved for the combination of Compound 1 with azacitidine in R/R AMLand an ORR of 78% was observed in TN AML (CR/CRi of 66%). TreatmentDiscontinuation was caused by: PD (6), transplant (6), investigator'sdecision (5), death (4), AE (2), and others: treatment failure, hospice,other treatment (1 each). 37% of patients (AML and MDS) remain ontreatment.

In some methods, Compound 1 can be administered with cytarabine. Lowdose cytarabine (LDAC) can be administered to certain AML patients(e.g., AML patients at or above about 60 years of age who are notcandidates for intensive therapy, and harboring a R132X mIDH-1mutation). The therapeutically effective combination of Compound 1 withLDAC can be administered to AML patients harboring IDH1 mutation. Forexample, patients can be administered the Compound 1 daily (BID) incontinuous 28-day cycles, alone or in combination with LDAC(administered at the dose of 20 mg BID SC for 10 days every 28-daycycle) until treatment discontinuation.

Subjects that are treated according to provided methods and combinationtherapies can have relapsed or refractory AML or MDS, or “high risk”MDS, and may have been previously treated with a mIDH1 inhibitor. Suchrefractory AML or MDS (i) can be naïve to prior hypomethylating therapyand IDH1 inhibitor therapy and/or (ii) may have shown inadequateresponse or progressed immediately preceding hypomethylating therapy.The provided methods and combination therapies can be used to treatsubjects with residual IDH-R132 mutations. The provided methods andcombination therapies can also be used to treat subjects with AML or MDSin morphologic complete remission or complete remission with incompleteblood count recovery (CR/CRi) after cytotoxic-containing inductiontherapy.

The methods of treatment are based in part on a human clinical study ofadministration of Compound 1 in 3 stages: a phase 1 dose-escalationstage, a phase 1 dose-expansion stage and a phase 2 stage, as furtherdescribed in the Examples. Single agent Compound 1 dose escalation wasadministered in once-daily (QD) doses of 150 and 300 mg, a twice-daily(BID) dose of 150 mg or a once daily dose of 100 and 150 mg with food topotentially improve bioavailability. During the course of single agentdose escalation, a parallel escalation arm can be initiated for Compound1 in combination with azacitidine. This combination can be initiatedonce the first dose level cohort of Compound 1 in the single agentschedule (150 mg QD) is complete. Once the maximum tolerated dose or themaximum evaluated dose is identified for the single-agent andcombination cohorts, select populations of patients can be enrolled intophase 1 dose expansion cohorts at the selected single agent orcombination doses, to further characterize the safety profile andconfirm the recommended phase 2 dose. After the recommended phase 2 dosein combination with azacitidine is selected, a cohort of 6 patients aretreated with Compound 1, at that dose, in combination with low dosecytarabine. In the Phase 2 portion, specific populations of patientswith AML/MDS harboring IDH1-R132 mutations are enrolled to receiveCompound 1 either as a single agent or in combination with azacitidineat the recommended phase 2 doses.

As outlined in Examples 11 and 13, Compound 1 demonstrates clinicalactivity as single agent in a high-risk Phase 1 population of AML/MDSpatients with IDH1 mutation. 41% CR/CRh/CRi in R/R AML (35% in allAML/MDS) was observed in patients treated with Compound 1 as a singleagent. Transfusion independence was observed in both IWGresponders/non-responders. Durable disease control or stable disease4-12+ months was observed in R/R AML. An observed reduction in bonemarrow blasts is supportive of clinical benefit to patients. Compound 1was well tolerated with patients maintained in treatment for a median of5.6 months, likely contributing to rate and depth (CR/CRh) of response.Compound 1 plasma exposure correlates with 2-HG response. Compound 1 Cssreduction of 2-HG supports 150 mg BID as the dose and schedule selectedfor evaluation in global Phase 2 trial outlined in FIG. 8B.

As outlined in Examples 11 and 13, the combination of Compound 1 andazacitidine demonstrates clinical activity in a high-risk Phase 1population of AML/MDS patients with IDH1 mutation. Patients maintainedtreatment for a median of 5 months. Durable disease control (>6 months)was observed in the absence of IWG response. 46% ORR and 35% CR/CRh/CRiin R/R AML, 78% ORR in TN AML was observed. Compound 1 is well toleratedin combination with azacitidine and possesses low risk of QTprolongation (2 AEs reported). Azacitidine combination modestlyincreased metabolic and gastrointestinal treatment emergent adverseevents (TEAEs). Higher rates of neutropenia compared to SA treatment(Grade 3/4 17% vs 6%) were observed which may be impacting the depth(CR/CRh) response. Compound 1 plasma exposure was shown to correlatewith 2-HG response. Compound 1 Css reduction of 2-HG supports selectionof 150 mg BID as RP2D.

In some embodiments, the present disclosure additionally providesmethods of treating AML or MDS in a patient harboring isocitratedehydrogenase 1 mutations (mIDH1), which can comprise administering to apatient in need thereof a therapeutically effective amount of Compound 1each day for at least three consecutive treatment cycles of 28consecutive days each. The administration of a therapeutically effectiveamount of Compound 1 can result in the patient having a durabletherapeutically effective trough blood plasma concentration of Compound1 in the patient throughout the course of treatment.

In some embodiments, the administration of a therapeutically effectiveamount of Compound 1 can result in the level of 2-HG in the patient'splasma being maintained at or below about 200 ng/mL at the start of thethird consecutive treatment cycle (e.g., prior to dosing on day 15 orCycle 3, Day 1), and the steady state blood plasma concentration ofCompound 1 in the patient being maintained at or above about 2,000 ng/mLand below about 7,500 ng/mL (preferably, below about 7,200 ng/mL)throughout the course of treatment. In some embodiments, the steadystate blood plasma concentration of Compound 1 in the patient ismaintained at or above about 1652 ng/mL and below about 7,840 ng/mLthroughout the course of treatment.

Maintaining Therapeutically Effective Blood Plasma Concentration ofCompound 1 Throughout a Course of Treatment

The disclosure is based in part on the discovery that oraladministration of Compound 1 (in the pharmaceutically acceptable oraldosage form resulting from the preparation method of Example 5) tohumans can provide steady state (trough) blood concentrations above atherapeutically effective amount (e.g., above the IC90 concentration forR132H and/or R132C mIDH-1, and/or concentrations of greater than about2,000 ng/mL) throughout a course of treatment of at least up to 30 weeksand beyond starting from the initial administration of Compound 1.Compound 1 can be administered to patients having elevated blood 2-HGlevels (i.e., above about 180 ng/mL), leading to a reduction in 2-HGlevels in the blood within 15 consecutive days starting with the firstday of the administration of Compound 1, followed by maintaining thelevels of 2-HG to below 200 ng/mL throughout the ensuing course oftreatment. Alternatively, Compound 1 can be administered to patientshaving elevated blood 2-HG levels (i.e., above about 180 ng/mL), leadingto a reduction in 2-HG levels in the blood within 15 consecutive daysstarting with the first day of the administration of Compound 1,followed by maintaining the levels of 2-HG to below 180 ng/mL throughoutthe ensuing course of treatment. Compound 1 was administered in an oraldosage form (obtainable from the method in Example 5) twice per day (150mg BID). After the initial 15 days of treatment with 150 mg BID of thisoral dosage form of Compound 1, the steady state (trough) bloodconcentration of Compound 1 (pre-dose) was maintained above about 2,000ng/mL and well below the predicted threshold for QTc risk (e.g., belowabout 7,200 ng/mL) throughout a course of treatment (e.g., at least upto about 30 weeks or longer, including 12-30 weeks or up to 6 months orlonger, from initial administration of Compound 1). Alternatively, afterthe initial 15 days of treatment with 150 mg BID of this oral dosageform of Compound 1, the steady state (trough) blood concentration ofCompound 1 (pre-dose) was maintained above about 1652 ng/mL and wellbelow the predicted threshold for QTc risk (e.g., below about 7840ng/mL) throughout a course of treatment (e.g., at least up to about 30weeks or longer, including 12-30 weeks or up to 6 months or longer, frominitial administration of Compound 1). In some embodiments of themethods of treatment disclosed herein, the steady state bloodconcentration of Compound 1 after day 15 is maintained at greater thanabout 10-times the measured blood concentrations of 2-HG in the patient(e.g., at or below about 200 ng/mL). A R132X mIDH-1 Selective InhibitorTherapy provides administering to a patient in need thereof a total doseof 150 mg BID of a pharmaceutically acceptable form of Compound 1provided in Example 5 in an oral dosage form, on consecutive daysthroughout a Course of Treatment. Compound 1 is preferably the onlyinhibitor of mutant IDH-1 (mIDH-1) having one or more R132X mIDH-1mutation(s) administered to the patient throughout the Course ofTreatment of the R132X mIDH-1 Selective Inhibitor Therapy. Unlessotherwise indicated, the mIDH-1 selective inhibitor (e.g. Compound 1)can be administered as a single agent as the R132X mIDH-1 SelectiveInhibitor Therapy, or in combination with other therapeutic agents thatare not mIDH-1 inhibitors as a combination for the R132X mIDH-1Selective Inhibitor Therapy.

Compound 1 is a potent and selective small molecule inhibitor of certainmutated forms of the isocitrate dehydrogenase 1 (IDH-1) enzyme. Compound1 selectively inhibits mutant IDH-1 enzymes compared to the wild typeIDH-1 enzyme, targeting the mutant IDH-1 variants defined herein asR132X mIDH-1 Mutation(s). Example 1 provides in vitro data demonstratinginhibition of various R132X mutations of mIDH-1 enzyme. For example,Compound 1 targets the mutant IDH-1 variants R132H, R132C, R132L, R132G,and R132S using assays described in Example 1 with IC50 concentrationsthat are approximately at least 180-fold lower than the wild-type IDH-1enzyme in vitro. In addition, Compound 1 targets the R132H and R132Cmutations of IDH-1 at IC50 concentrations demonstrating selectivity overwild-type IDH-1 enzyme in vitro (based on IC50 measurements asdetermined in Example 1 based on average+/−SEM, nM). Accordingly,preferred R132X mutations include R132H and R132C, as well as R132L,R132G, and R132S (or other R132X mutations having therapeuticallyrelevant 2-HG IC50 values obtained using the in vitro assay of Example1). In addition, Compound 1 selectively inhibits mutant IDH-1 comparedto mutant IDH-2 forms. The selectivity of Compound 1 against other IDHisozymes was tested using diaphorase coupled assays employing eitherwild-type IDH-1 or one of 2 alternative mutated forms of IDH-2 (R140Qand R172K). Compound 1 had very weak activity against either wild typeIDH-1 or R172K IDH-2 mutation (with enzymatic IC50 measurements obtainedaccording to Example 1 of about 20-25 micromolar, compared with IC50values of less than about 150 nanomolar obtained for the R132X m-IDH-1Mutations). In addition, Compound 1 did not show any inhibition of R140QIDH-2 up to a concentration of 100 micromolar. These selectivity datademonstrate that Compound 1 is a potent and selective inhibitor ofenzymes harboring R132X mIDH-1 Mutation(s).

The R132X mIDH-1 Selective Inhibitor Therapy (single agent orcombination) can be administered to adult patients with an IDH-1mutation as detected by a medically appropriate (e.g., FDA-approved)test for mIDH-1 mutation(s). Preferably, the test is a diagnostic thatidentifies an R132X mIDH-1 Mutation(s) in the patient prior to theadministration of Compound 1. Preferably, the patient is identified asharboring one or more R132X mIDH-1 Mutation(s) based on Next GenerationSequencing (NGS) detection on a tissue sample obtained from the patientprior to the administration of Compound 1 and/or administration of anyR132X mIDH-1 Selective Inhibitor Therapy.

A patient in need of R132X mIDH-1 Selective Inhibitor Therapy can havean elevated level of 2-HG measured in the patient (e.g., in the bloodplasma of the patient) prior to initiating any R132X mIDH-1 SelectiveInhibitor Therapy. Preferably, the level of 2-HG measured in the bloodof the patient declines during the first 2 weeks of the Course ofTreatment of a R132X mIDH-1 Selective Inhibitor Therapy. For example, apatient may have a measured blood concentration level of 2-HG that isgreater than about 200 ng/mL of 2-HG prior to the administration ofCompound 1 pursuant to administration of a R132X mIDH-1 SelectiveInhibitor Therapy to the patient in need thereof, and a measured bloodconcentration level of 2-HG of less than about 200 ng/mL during a Courseof Treatment with a R132X mIDH-1 Selective Inhibitor Therapy. Forexample, in the human clinical trial disclosed in Example 11, allIDH-1m+ patients had elevated 2-HG, which was reduced upon treatmentwith Compound 1 by day 15 of the Course of Treatment, with about 30%demonstrating a response to the administration of Compound 1 at somepoint during the Course of Treatment. In this patient population, thenormal 2-HG measured in patient blood at CRL was about 70±17 ng/mL; theobserved highest was about 91 ng/mL and the lowest was about 43 ng/mL.Preferably, the R132X mIDH-1 Selective Inhibitor Therapy consists of theadministration of Compound 1 (i.e., Compound 1 is the only mDH-1inhibitor administered to the patient throughout the Course ofTreatment).

Compound 1 is administered over a therapeutically effective Course ofTreatment, which is preferably long enough to provide and sustain anintended therapeutic effect. For example, the Course of Treatment can belong enough to therapeutically reduce elevated 2-HG levels in a patient(e.g., reduce 2-HG levels measured in patient blood plasma to belowabout 200 ng/mL), with continued administration of Compound 1 to thepatient in a manner that provides therapeutically effective steady stateblood plasma concentration levels of Compound 1 (e.g., trough bloodplasma concentrations greater than the IC90 concentration value for 2HGproduction measured for a R132X IDH-1 mutation identified in cellsobtained from the patient). When treating patients with elevated 2-HGlevels measured in the patient's blood prior to administration ofCompound 1, the Course of Treatment can be at least a number ofconsecutive days starting from the initial administration of Compound 1to the patient with elevated 2-HG levels, and continuing with dailyadministration of Compound 1 (e.g., 150 mg BID) for at least a number ofdays effective to reduce the 2-HG levels measured in the blood of thepatient to less than about 200 ng/mL (preferably less than 180 ng/mL)and/or a level considered medically appropriate for the patient (e.g.,to a range determined to be medically normal for that patient in thetreatment paradigm). Preferably, the Course of Treatment is at least 15consecutive days starting with the day of the initial administration ofCompound 1 to the patient and comprises 150 mg of the solid oral dosageform of Compound 1 (e.g., Example 5) administered to the patient twiceper day (e.g., every 12 hours) every day for at least 15 days. TheCourse of Treatment can be one or more 28-day treatment cycles of dailyBID administration of 150 mg of Compound 1 in the solid oral dosage formobtained from Example 5. The Course of Treatment can continue throughouta medically appropriate number of days for a patient. For example, theCourse of Treatment can last for any medically appropriate number ofconsecutive 28-day treatment cycles, including a Course of Treatmentlasting for 1, 2, 3, 4, 5, 6 consecutive treatment cycles of 28-dayseach, and/or a Course of Treatment of 20 weeks, and/or a Course ofTreatment of 6 months or more. In some methods, the Course of Treatmentis at least 6 months, or between at least 15 consecutive days and 6months of consecutive days of treatment comprising administration of 150mg BID of Compound 1 in a pharmaceutical form obtained from Example 5.

The R132X mIDH-1 Selective Inhibitor Therapy (e.g., oral administrationof 150 mg BID of Compound 1 throughout a Course of Treatment) providedunexpectedly durable blood concentration levels throughout the Course ofTreatment exceeding 6 months. The level of steady state bloodconcentration during the Course of Treatment was durable, meaning thatthe steady state blood concentration of Compound 1 did not decrease bymore than 10% throughout a Course of Treatment with continuedadministration of Compound 1 at a dose of 150 mg BID each day, whileremaining within a therapeutic concentration window defined by a minimumconcentration above the IC90 determined in vitro for the 2-HG productionof a R132X mIDH-1 mutation harbored by the patient (e.g., above about2,000 ng/mL or above about 1652 ng/mL), and a maximum concentrationvalue below the concentration associated with medically unacceptablerisk of QTc prolongation (e.g., about 7,200 ng/mL or about 7840 ng/mL).

In addition, the R132X mIDH-1 Selective Inhibitor Therapy can reduce2-HG levels in the blood of the patient, although this reduction did notcorrelate with disease response in the patients during the Course ofTreatment. As shown in FIGS. 19A-19D, the R132X mIDH-1 SelectiveInhibitor Therapy provided a sustained reduction in 2HG levels, meaningthat elevated levels of the blood concentration of 2-HG in patient bloodplasma were reduced relative to pre-dose levels during the initialportion of a Course of Treatment (e.g., within the first 15 days) andthen sustained at or below about the pre-dose level throughout the restof the Course of Treatment (e.g., at or below about 200 ng/mL for 6consecutive 28-day treatment cycles or at or below about 180 ng/mL for 6consecutive 28-day treatment cycles).

FIGS. 18A-18E is a graph showing the steady state (trough) bloodconcentration measured in patients after administration of 150 mg ofCompound 1 BID, as described in the human clinical trial of Example 11.FIGS. 18A-18E are different graphs each showing the steady state bloodconcentration of Compound 1 measured in patient blood for a collectionof patients in the human clinical trial described in Example 11. FIGS.18A-18E are each graphs showing the measured steady state bloodconcentrations measured in each of individual patients included in thepopulation, at the indicated time points, in the human clinical trial ofExample 11. Notably, the steady state blood concentration of Compound 1remained above a therapeutic minimum value (e.g., the IC90 value for2-HG production by at least one of the R132X mutation(s) identified inpatient's tissue prior to administration of Compound 1) throughout theCourse of Treatment (e.g., 30 weeks). In particular, the administrationof Compound 1 in the oral dosage form described in Example 5 at 150 mgBID resulted in a sustained therapeutically effective trough bloodplasma concentration above 2,000 ng/mL throughout a 30-week Course ofTreatment as shown in FIGS. 18A-18E (e.g., including after cycle 3 of a28-day treatment cycle, after week 20 and continuing to week 30). Thetrough concentration measurements of Compound 1 in patient blood did notdecline below a therapeutically effective level at each point measuredduring the Course of Treatment. Referring to FIGS. 19A-19D, theadministration of Compound 1 in the oral dosage form from Example 5 at150 mg BID in the human clinical trial of Example 11 resulted in asustained 2-HG level under 200 ng/mL in plasma throughout the Course ofTreatment ranging from cycle 2, day 1 through cycle 8, day 1 (each cyclerepresents 28 consecutive days of oral administration of 150 mg BID ofthe solid form of Compound 1 obtainable from the production method ofExample 5).

This disclosure is based in part on the discovery that a R132X mIDH-1Selective Inhibitor Therapy where Compound 1 is the only mIDH-1inhibitor administered (administration of Compound 1 at 150 mg BID)unexpectedly resulted in a steady state blood concentration that wasdurable (e.g., blood plasma steady state concentration of Compound 1remains within about 20% (or does not decrease by more than about 20%),and preferably remains within 10% (or does not decrease by more than10%) of the concentration measured the day after the initial 28-daycycle in a Course of Treatment). In addition, the administration ofCompound 1 as described in Example 11 reduced elevated 2-HGconcentrations in the blood of the patients within about 15 days andthen sustained patient blood concentrations of 2-HG at less than about200 ng/mL after about 15 days of a Course of Treatment.

The R132X mIDH-1 Selective Inhibitor Therapy can provide a sustainedratio of greater than about 10 (preferably greater than about 20) ofblood plasma concentration of Compound 1 (e.g., trough concentrationsmeasured pre-dose at concentrations of about 2,000 ng/mL or greater) to2-HG blood level (e.g, concentrations of plasma concentrations of about200 ng/mL or lower, including concentrations of about 100 ng/mL) aftercycle 3 day 1 (i.e., after BID doses administered over the initial 15consecutive days of treatment) of a 28-day treatment cycle. A plasmahalf-life of about 60 hours was estimated for Compound 1, with steadystate achieved by week 2 of the course of treatment. The steady stateblood concentrations of Compound 1 measured in the patients was abovethe IC90 value for 2-HG inhibition in R132X mIDH-1 cells (described inthe Examples). As shown in FIGS. 18A-18E, the plasma exposures (steadystate blood plasma concentration) of Compound 1 were durable (i.e.,sustained) throughout the 30-week treatment duration. As shown in FIGS.19A-19D, the plasma 2-HG concentrations were reduced to the normal rangewithin 1 cycle (C2D1) and maintained throughout the treatment duration.No dose limiting toxicities of Compound 1 were observed during doseescalation studies, and the maximum tolerated dose (MTD) of Compound 1was not reached. Preferably, the R132X mIDH-1 Selective InhibitorTherapy can be administered to a patient that has not received any otherR132X mIDH-1 inhibitor compound.

As described in Example 11, FIG. 21A shows the ratio of the steady stateblood concentration of Compound 1, normalized to 1.0 using theconcentration measured on day 15 of a Course of Treatment, for a singlepatient who received 150 mg BID of the solid form of Compound 1obtainable from Example 5 throughout a Course of Treatment of over 300days (i.e., greater than 6 months). The steady state blood exposure(concentration) of Compound 1 varied from about 90-133% of theconcentration of Compound 1 measured in the patient at cycle 1, day 15,throughout the subsequent remainder of this Course of Treatment.

Optionally, a hypomethylating agent and/or a nucleic acid synthesisinhibitor can also be administered to the patient during the Course ofTreatment. Suitable agents that can also be administered during theCourse of Treatment include azacitabine and/or decitabine.

In some embodiments, a combination therapy of Compound 1 and azacitidinecan be administered for the treatment of patients with certain forms ofcancer (e.g., glioma) harboring IDH-1 mutations. For example, patientscan be administered Compound 1 daily (BID) in continuous 28-day cycles,in combination with azacitidine (administered at the dose of 75 mg/m²for 7 days IV/SC per every 28-day cycle). Azacitidine (also, azacytidineor AZA herein) is believed to exert its antineoplastic effects bycausing hypomethylation of DNA and direct cytotoxicity on abnormalhematopoietic cells in the bone marrow. Azacitidine can be administeredduring a Course of Treatment at a subcutaneous dose of 75 mg/m² dailyfor 7 days every 4 weeks. The azacitidine dose can be increased to 100mg/m² if no beneficial effect was seen after 2 treatment cycles. Thedose of azacitidine can be decreased and/or delayed based on hematologicresponse or evidence of renal toxicity. Azacitidine is indicated fortreatment of patients with the following myelodysplastic syndromesubtypes: refractory anemia or refractory anemia with ringedsideroblasts (if accompanied by neutropenia or thrombocytopenia orrequiring transfusions), refractory anemia with excess blasts,refractory anemia with excess blasts in transformation, and chronicmyelomonocytic leukemia. In some embodiments, a method of treatmentcomprises (a) the (e.g., oral) administration of a total of 150 mg ofCompound 1 BID to a patient throughout a Course of Treatment; and (b)administering a therapeutically effective amount of azacitidine to thepatient (e.g, administering azacitidine at a dose of 75 mg/m² daily for7 days every 4 weeks, wherein the azacitidine dose can be increased to100 mg/m² if no beneficial effect was seen after 2 treatment cycles andthe dose of azacitidine can be decreased and/or delayed based onhematologic response or evidence of renal toxicity).

Decacitabine (5-aza-2′-deoxycytidine) is a nucleoside metabolicinhibitor indicated for treatment of patients with myelodysplasticsyndromes (MDS) including previously treated and untreated, de novo andsecondary MDS of all French-American-British subtypes (refractoryanemia, refractory anemia with ringed sideroblasts, refractory anemiawith excess blasts, refractory anemia with excess blasts intransformation, and chronic myelomonocytic leukemia) and intermediate-1,intermediate-2, and high-risk International Prognostic Scoring Systemgroups. In some embodiments, a method of treatment comprises the (e.g.,oral) administration of a total of 150 mg of Compound 1 BID to a patientthroughout a Course of Treatment; and (b) administering atherapeutically effective amount of decacitabine to the patient (e.g,administering decacitabine at a dose of 15 mg/m² by continuousintravenous infusion over 3 hours repeated every 8 hours for 3 days andrepeating this cycle every 6 weeks; or administering the decacitabine ata dose of 20 mg/m² by continuous intravenous infusion over 1 hourrepeated daily for 5 days. Repeat cycle every 4 weeks).

Glioma

The present disclosure also provides methods for treating solid tumorsin the CNS, including a brain cancer tumor, harboring a R132 IDH-1mutation. For example, patients diagnosed with brain cancer harboring amutant IDH-1 cancer cell can be treated with a therapeutically effectiveamount of Compound 1 in combination with azacitidine.

Compound 1 is a small molecule inhibitor of mutated forms of isocitratedehydrogenase 1 (IDH-1) enzyme, and is useful for the treatment of adultpatients diagnosed with cancer having an IDH-1 mutation as detected byan FDA-approved test. Compound 1 can be administered to patients in needthereof in a therapeutically effective amount (e.g., 150 mg orally twicedaily until disease progression or unacceptable toxicity). Patients forthe treatment of cancer with Compound 1 can be selected based on thepresence of IDH-1 mutations in the blood or bone marrow. In oneembodiment, the recommended starting dose of Compound 1 is 150 mg takenorally twice daily with or without food until disease progression orunacceptable toxicity. For patients without disease progression orunacceptable toxicity, the patient can receive the therapeuticallyeffective amount of Compound 1 for a minimum of 6 months to allow timefor clinical response.

The disclosure is based in part on preclinical studies showing thatCompound 1 can cross the blood brain barrier (BBB) in mouse models. Oraladministration of Compound 1 showed high systemic bioavailabilty inmultiple preclinical species. Permeability was excellent, with littleevidence of efflux, and significant brain penetration was observed inmice (98% brain binding in murine animal model).

Preferably, patients diagnosed with glioma harboring a R132 IDH-1mutation can be treated with a therapeutically effective combination ofa pharmaceutical composition of Compound 1 (e.g., an oral dosage formproviding 150 mg of Compound 1 administered twice per day on consecutivedays for a course of treatment comprising multiple treatment cyclestotaling at least 6 months) and azacitidine. The azacitidine can besubcutaneously or intravenously administered to the patient in anazacitidine treatment cycle consisting of the administration of a totaldose of 75 mg/m² each day for 7 consecutive days beginning at the startof each treatment cycle, followed by 21 consecutive days withoutadministration of the azacitidine to the patient. A 48-hourdose-interruption of azacitidine is allowed for weekends or holidays. Ifno response is seen after 2 treatment cycles, azacitidine can beadministered at a total dose of 100 mg/m² each day.

Compound 1 is preferably administered on consecutive days throughout aCourse of Treatment. For example, a Course of Treatment can comprise oneor more 28-day treatment cycles. Preferably, the Course of Treatment isat least about 15 consecutive days, at least about a 28-consecutive daytreatment cycle, or at least about four, five, six or more consecutive28-day treatment cycles and more preferably, at least about 4 months orlonger (e.g., 6 months or longer). Preferably, Compound 1 isadministered twice per day (e.g., about every 12 hours) every daythroughout a Course of Treatment.

In some embodiments, patients can be treated with Compound 1 incombination with a hypomethylating agent such as azacitidine ordecitabine. The recommended starting dose for azacitidine in the firsttreatment cycle, for all patients regardless of baseline hematologylaboratory values, is 75 mg/m² of body surface area, injectedsubcutaneously, daily for 7 days, followed by a rest period of 21 days(28-day treatment cycle). It is recommended that patients be treated fora minimum of 6 cycles. Treatment should be continued as long as thepatient continues to benefit or until disease progression. In somemethods, azacitidine is administered to the patient in need thereof at adose of 75 mg/m², SC, d1-7, q4 wk throughout a course of treatment,while receiving Compound 1 at a dose of 150 mg BID. In other methods,decitabine is administered to the patient in need thereof at a dose of20 mg/m², IV, d1-5, q4 wk, while receiving Compound 1 at a dose of 150mg BID.

In one embodiment, patients diagnosed with glioma harboring a mIDH1 canbe treated with a mIDH1 Inhibitor Therapy consisting of Compound 1 andazacitidine. Treatment with the hypomethylating agent azacitidine cancause tumor growth inhibition in a patient-derived IDH1-mutated gliomamodel by reducing DNA methylation and inducing glial differentiation.IDH1 R132H mutations represent more than 90% of the IDH mutationspresent in low grade glioma and secondary GBM patients. The IDH1mutations R132C and R132S are also reported in glioma patients. At leastin mIDH1 harboring cancer cells, wild type and mutant IDH1 form aheterodimeric complex that can produce very high 2-HG levels (up to 3-35mM in glioma cells). For example, patients bearing IDH1 mutations haveelevated levels of 2-HG, which in some cases reach tumorconcentrations >10 mM (glioma).

In another embodiment, patients diagnosed with chondrosarcoma harboringa mutant IDH1 cancer cell can be treated with a therapeuticallyeffective amount of Compound 1 alone or in combination with azacitidine.In some embodiments, a combination therapy comprising Compound 1 andazacitidine can be administered for the treatment of patients withchondrosarcoma harboring IDH1 mutations. For example, patients can beadministered Compound 1 daily (BID) in continuous 28-day cycles, incombination with azacitidine (administered at the daily dose of 75 mg/m²for 7 days IV/SC per every 28-day cycle).

Preferably, patients treated with a combination of Compound 1 andazacitidine receive a therapeutically effective amount of a mIDH1Inhibitor Therapy selected from a dose level indicated in Table 3 below.

TABLE 3 Preferred Dose Levels for mIDH1 Inhibitor Therapy withAzacitidine Dose Level Compound 1 Azacitidine 1 (Starting Dose) 150 mgBID continuously 75 mg/m²/day x 7 days for 28 consecutive days every 28days −1 (Hematologic 150 mg BID continuously 37 mg/m²/day x 7 daysDose-Limiting for 28 consecutive days every 28 days Toxicity (DLT)) −1(non- 150 mg BID continuously 75 mg/m²/day x 7 days Hematologic DLT) for28 consecutive days every 28 days

Patients diagnosed with hepatobiliary carcinoma (HBC) harboring a mutantIDH1 cancer cell can be treated with a therapeutically effective amountof Compound 1 alone or in combination with a PD-1 inhibitor (e.g.,Pembrolizumab (Keytruda) or Nivolumab (Opdivo)). In some embodiments, acombination therapy of Compound 1 and the PD-1 inhibitor can beadministered for the treatment of patients with a HBC cancer harboringIDH1 mutations. For example, patients can be administered compound 1daily (BID) in continuous 28-day cycles, in combination withPembrolizumab (e.g., administered at the dose of 200 mg every 3 weeks).For example, patients can be administered compound 1 daily (BID) incontinuous 28-day cycles, in combination with Nivolumab (e.g.,administered at the dose of 240 mg every 2 weeks or 480 mg every 4weeks). Preferably, patients treated with a combination comprisingCompound 1 and Nivolumab receive a therapeutically effective amount of amIDH1 Inhibitor Therapy selected from a dose level indicated in Table 4below.

TABLE 4 Preferred Dose Levels for mIDH1 Inhibitor Therapy with NivolumabDose Level Compound 1 Nivolumab 1 (Starting Dose) 150 mg BIDcontinuously 240 mg intravenous for 28 consecutive days every 2 weeks −1(any DLT) 150 mg once daily 240 mg intravenous continuously for 28 every2 weeks consecutive days

Patients diagnosed with IHCC harboring a mutant IDH1 cancer cell can betreated with a therapeutically effective amount of Compound 1 alone orin combination with a chemotherapy (e.g., gemcitabine and cisplatin).Preferably, patients treated with a combination of Compound 1 andgemcitabine and cisplatin chemotherapy receive a therapeuticallyeffective amount of a mIDH1 Inhibitor Therapy selected from a dose levelindicated in Table 5 below.

TABLE 5 Preferred Dose Levels for mIDH1 Inhibitor Therapy withGemcitabine/Cisplatin Dose Level Compound 1 Gemcitabine/Cisplatin 1(Starting 150 mg BID continuously Cisplatin 25 mg/m² followed Dose) for28 consecutive days by gemcitabine 1,000 mg/m² on Day 1 and Day 8 −1(any 150 mg once daily Cisplatin 25 mg/m² followed DLT) continuously for28 by gemcitabine 1,000 mg/m² consecutive days on Day 1 and Day 8Diagnostic Methods

Patients can be selected for treatment according to methods describedherein using various diagnostic technologies. A patient can beidentified as having a R132X mutation in mIDH1 using a diagnostic methoddisclosed herein prior to the administration of Compound 1 to thepatient. The R132X gene mutation can be determined prior toadministration of Compound 1 to the patient. Compound 1 can beadministered to patients who have received prior anticancer therapy orother concomitant (non-anticancer) medications. In some examples,Compound 1 is administered to patient who has not received a priormIDH-1 inhibitor therapy.

In some embodiments, the present disclosure provides methods of treatingacute myeloid leukemia (AML) in patients with an isocitratedehydrogenase-1 (IDH1) mutation, the method comprising steps of:

-   -   a. providing DNA from a sample obtained from a patient;    -   b. detecting an IDH1 mutation in the DNA from the sample; and    -   c. administering to the patient with the IDH1 mutation a total        of 150 mg of Compound 1 twice daily in a pharmaceutically        acceptable composition.

In some embodiments, the present disclosure provides methods of treatingacute myeloid leukemia (AML) in patients with an isocitratedehydrogenase-1 (IDH1) mutation, the method comprising steps of:

-   -   a. isolating and purifying DNA from a sample obtained from a        patient;    -   b. detecting an IDH1 mutation in the DNA from the sample; and    -   c. administering to the patient with the IDH1 mutation a total        of 150 mg of Compound 1 twice daily in a pharmaceutically        acceptable composition.

In some embodiments, the present disclosure provides methods of treatingAML in patients with an isocitrate dehydrogenase-1 (IDH1) mutation, themethod comprising steps of: determining whether the patient has an IDH1mutation by:

-   -   i. obtaining a sample from the patient; and    -   ii. performing an assay (e.g., an FDA-approved diagnostic test,        such as the IDH1 Assay of Example 14) on the sample to determine        if the patient has an IDH1 mutation; and        -   if the patient has an IDH1 mutation, then administering to            the patient with the IDH1 mutation a total of 150 mg of            Compound 1 twice daily in a pharmaceutically acceptable            composition, and        -   if the patient does not have an IDH1 mutation, then not            administering to the patient with the IDH1 mutation a total            of 150 mg of Compound 1 twice daily in a pharmaceutically            acceptable composition.

The present disclosure also provides methods of treating acute myeloidleukemia (AML) in patients with an isocitrate dehydrogenase-1 (IDH1)mutation, the method comprising administering twice daily to a patientwith an IDH1 mutation 150 mg of Compound 1 in a pharmaceuticallyacceptable composition, wherein the IDH1 mutation has been detectedusing an FDA-approved diagnostic test.

In some embodiments, the present disclosure provides methods of treatingglioma in patients with an isocitrate dehydrogenase-1 (IDH1) mutation,the method comprising steps of:

-   -   a. providing DNA from a sample obtained from a patient;    -   b. detecting an IDH1 mutation in the DNA from the sample; and    -   c. administering to the patient with the IDH1 mutation a total        of 150 mg of Compound 1 twice daily in a pharmaceutically        acceptable composition.

In some embodiments, the present disclosure provides methods of treatingglioma in patients with an isocitrate dehydrogenase-1 (IDH1) mutation,the method comprising steps of:

-   -   a. isolating and purifying DNA from a sample obtained from a        patient;    -   b. detecting an IDH1 mutation in the DNA from the sample; and    -   c. administering to the patient with the IDH1 mutation a total        of 150 mg of Compound 1 twice daily in a pharmaceutically        acceptable composition.

In some embodiments, the present disclosure provides methods of treatingglioma in patients with an isocitrate dehydrogenase-1 (IDH1) mutation,the method comprising steps of: determining whether the patient has anIDH1 mutation by:

-   -   i. obtaining a sample from the patient; and    -   ii. performing an assay (e.g., an FDA-approved diagnostic test,        such as the IDH1 Assay of Example 14) on the sample to determine        if the patient has an IDH1 mutation; and        -   if the patient has an IDH1 mutation, then administering to            the patient with the IDH1 mutation a total of 150 mg of            Compound 1 twice daily in a pharmaceutically acceptable            composition, and        -   if the patient does not have an IDH1 mutation, then not            administering to the patient with the IDH1 mutation a total            of 150 mg of Compound 1 twice daily in a pharmaceutically            acceptable composition.

The present disclosure also provides methods of treating glioma inpatients with an isocitrate dehydrogenase-1 (IDH1) mutation, the methodcomprising administering twice daily to a patient with an IDH1 mutation150 mg of Compound 1 in a pharmaceutically acceptable composition,wherein the IDH1 mutation has been detected using an FDA-approveddiagnostic test.

In some embodiments, the IDH1 mutation is an IDH1 R132 mutation.Examples of an IDH1 R132 mutation include R132C, R132H, R132S, R132G,and R132L. In some embodiments, the IDH1 R132 mutation is R132C. In someembodiments, the IDH1 R132 mutation is R132H. In some embodiments, theIDH1 R132 mutation is R132S. In some embodiments, the IDH1 R132 mutationis R132G. In some embodiments, the IDH1 R132 mutation is R132L. In someembodiments, the patient is harboring an IDH1 mutation, such as an IDH1R132 mutation selected from the group consisting of R132C, R132H, R132S,R132G, and R132L.

In some embodiments, the AML is relapsed or refractory AML.

In some embodiments, the patient is receiving or has received anticancertherapy. In some embodiments, the patient is resistant or refractory toprior anticancer therapy. In some embodiments, the patient is receivingor has received therapy comprising azacitidine or cytarabine.

Compound 1 can be administered as provided herein. For example, Compound1 can be administered as an oral dosage form, such as a tablet or acapsule. For example, Compound 1 can be administered as part of acombination therapy comprising, e.g., Compound 1 and azacitidine orcytarabine. For example, Compound 1 can be administered as the PRODUCTdescribed in Example 5.

In some embodiments, provided methods further comprise not administeringCompound 1 if the patient does not have an IDH1 mutation, as determined,e.g., by an FDA-approved diagnostic test.

In some embodiments, provided methods comprise detecting an IDH1mutation and administering Compound 1 as described herein. In someembodiments, IDH1 mutations can be detected using an FDA-approveddiagnostic test, such as the IDH1 Assay described in Example 14.

In some embodiments, detecting an IDH1 mutation comprises detecting asingle nucleotide variant (SNV) coding the IDH1 mutation. In someembodiments, the IDH1 mutation is selected from the group consisting ofR132C, R132H, R132G, R132S, and R132L. In some embodiments, detecting anIDH1 R132C mutation comprises detecting the SNV: TGT. In someembodiments, detecting an IDH1 R132H mutation comprises detecting theSNV: CAT. In some embodiments, detecting an IDH1 R132G mutationcomprises detecting the SNV: GGT. In some embodiments, detecting an IDH1R132S mutation comprises detecting the SNV: AGT. In some embodiments,detecting an IDH1 R132L mutation comprises detecting the SNV: CTT.

In some embodiments, the IDH1 mutation is detected using PCR technologywith homogenous real-time fluorescence detection. In some embodiments,the IDH1 mutation is detected using an in vitro polymerase chainreaction (PCR) assay for the qualitative detection of single nucleotidevariants (SNVs) coding an IDH1 R132 mutation selected from the groupconsisting of R132C, R132H, R132G, R132S, and R132L in the DNA from asample.

In some embodiments, the diagnostic test uses a sample obtained from thepatient. In some embodiments, the sample is a blood or tissue sample. Insome embodiments, the sample is patient bone marrow. In someembodiments, the sample is patient blood. In some embodiments, thesample has been preserved with EDTA.

In some embodiments, provided methods further comprise:

-   -   lysing cells from the sample at an elevated temperature in a        lysis buffer comprising guanidine isothiocyanate;    -   capturing DNA released from the lysed cells using magnetic        microparticles;    -   washing the captured DNA; and    -   eluting the captured DNA from the magnetic microparticles with        elution buffer to give an extracted DNA sample.

In some embodiments, provided methods further comprise:

-   -   combining the extracted DNA sample, a DNA polymerase,        oligonucleotide primers, deoxyribonucleoside triphosphates        (dNTPs), and magnesium chloride in a well of a 96-well plate to        give a mixture;    -   sealing the 96-well plate with a cover;    -   activating the DNA polymerase at a high temperature;    -   subjecting the mixture to thermal cycling comprising multiple        rounds of heating (e.g., to a high temperature suitable to melt        double-stranded DNA) and cooling (e.g., to a low temperature        suitable to promote annealing of primers to their respective        targets); and    -   measuring the real-time fluorescence signals of the mixture.

In some embodiments, the oligonucleotide primers are designed tospecifically amplify (i) R132C and R132H mutations or (ii) R132G, R132S,and R132L mutations. In some embodiments, the oligonucleotide primersare designed to specifically amplify R132C and R132H mutations. In someembodiments, the oligonucleotide primers are designed to specificallyamplify R132G, R132S, and R132L mutations. In some embodiments, twosamples from the same patient are evaluated, so that one sample is mixedwith oligonucleotide primers that are designed to specifically amplifyR132C and R132H mutations and the other sample is mixed witholigonucleotide primers that are designed to specifically amplify R132G,R132S, and R132L mutations.

In some embodiments, the DNA polymerase is a thermophilic enzyme thathas been chemically modified to render it inactive at ambienttemperature.

In some embodiments, provided methods comprise an internal control. Forexample, in some embodiments, the mixture further comprisesoligonucleotide primers designed to amplify a region of the IDH1 geneoutside of codon 132, thereby serving as an endogenous internal control.

In some embodiments, the real-time fluorescence signal of each IDH1mutation of either (i) R132C and R132H or (ii) R132G, R132S, and R132Lis distinguishable in a single well. In some embodiments, the real-timefluorescence signal of the internal control and each IDH1 mutation ofeither (i) R132C and R132H or (ii) R132G, R132S, and R132L isdistinguishable in a single well.

Without wishing to be bound by any particular theory, it may bedesirable for a diagnostic test described herein to be performed in sucha way as to prevent nucleic acid contamination. In some embodiments, thediagnostic test is performed in a sealed 96-well plate. In someembodiments, the diagnostic test is performed without opening the sealed96-well plate. In some embodiments, aerosol barrier pipette tips areused for all pipetting in provided methods. In some embodiments, thediagnostic test is performed in a dedicated area.

In some embodiments, provided methods further comprise detecting aco-mutation described herein (e.g., using a method of detection asdescribed herein).

Compound 1

Referring to FIG. 5, Compound 1 can be prepared in a convergentsynthesis from Intermediate A and Intermediate B as shown in FIG. 5 viathe nucleophilic displacement reaction under basic conditions of(S)-3-(1-aminoethyl)-6-chloroquinolin-2(1H)-one (Intermediate A) and thefluoropyridone (Intermediate B). 1H, 13C NMR and mass spectral data areconsistent with the assigned structure. The asymmetric synthesis ofIntermediate A started with the condensation of the commerciallyavailable quinoline aldehyde (1) with (R)-tert-butanesulfinamide (2) toform the chiral (R)-N-tert-butanesulfinimine (3), followed by additionof methyl magnesium bromide in dichloromethane to yield the desiredproduct (4) as the major diastereoisomer (dr: 98:2). Cleavage of thechiral auxiliary and simultaneous hydrolysis of 2-chloroquinoline moietyunder mildly acidic conditions using 1N HCl in dioxane gave IntermediateA in quantitative yield. The structure of Intermediate A was confirmedby NMR and mass spectroscopy, and the enantiomeric purity was determinedby chiral SFC analysis. The (S)-stereochemistry was confirmed by X-rayco-crystal structures of several inhibitor analogs prepared from thesame chiral amine intermediate bound to mIDH-1 R132H. Intermediate (B)was prepared from commercially available 5-fluoropicolinonitrile in foursteps. N-oxidation of 5-fluoropicolinonitrile followed by reflux of theN-oxide in acetic anhydride gave the acetate, following work-up andpurification. Solvolysis of the acetate group followed by N-methylationunder standard conditions gave a mixture of N-methylated andO-methylated products (4:1). The minor O-methylated product was removedby column chromatography. NMR and mass spectral data are consistent withthe structure of Intermediate Compound (B). Compound 1(5-{[(1S)-1-(6-chloro-2-oxo-1,2-dihydroquinolin-3-yl)ethyl]amino}-1-methyl-6-oxo-1,6-dihydropyridine-2-carbonitrile)has a molecular weight of 355 with a melting point onset temperature of251.3° C. (DSC) and peak maximum 254.1° C.

Compound 1 is also known as olutasidenib. Compound 1 can also beidentified by the following chemical names:

-   2-Pyridinecarbonitrile,    5-[[(1S)-1-(6-chloro-1,2-dihydro-2-oxo-3-quinolinyl)ethyl]amino]-1,6-dihydro-1-methyl-6-oxo-;-   5-{[(1S)-1-(6-chloro-2-oxo-1,2-dihydroquinolin-3-yl)ethyl]amino}-1-methyl-6-oxo-1,6-dihydropyridine-2-carbonitrile;    and-   (S)-5-((1-(6-chloro-2-oxo-1,2-dihydroquinolin-3-yl)ethyl)amino)-1-methyl-6-oxo-1,6-dihydropyridine-2-carbonitrile.

Compound 1 also has the following identifiers:

-   -   Code designation: FT-2102    -   CAS Registry Number: 1887014-12-1    -   UNII: 0T4IMT8S5Z    -   WHO Number: 11036

An oral unit dosage form comprising a pharmaceutically acceptable solidform of Compound 1 (e.g., as obtained from Example 5) can be formulatedas a drug product with various inactive components as excipients (e.g.,as a tablet or capsule) (referred to as the “PRODUCT”). Each drugproduct excipient in PRODUCT meets the requirements of the respectivecurrent United States Pharmacopeia (USP) or National Formulary (NF)monograph. The capsule shells can comprise gelatin and about 2.9% w/w oftitanium dioxide (E171). Preferably, each oral unit dosage formcomprises a total of 50 mg or 150 mg of the pharmaceutically acceptableform of Compound 1 (e.g., micronized crystalline olutasidenib) combined(e.g., at 30-50% w/w) as the only active moiety with pharmaceuticallyacceptable excipients such as a filler (e.g., AVICEL PH101 @50 micron,AVICEL PH102 @100 micron), a disintegrant (e.g., Ac-Di-Sol), optionallyone or more compounds as a lubricant (e.g., magnesium stearate), aglidant/anti-adherent, and/or anti-static (e.g., colloidal silicondioxide). The excipients can form about 50-70% by weight of thepharmaceutical oral unit dosage form. In one example, a capsule ortablet comprises a total of about 33% of Compound 1, with the remainingweight of the capsule or tablet is formed from excipients and/or capsulematerial (e.g., a gelatin). Alternatively, the PRODUCT can be provide astablet for oral administration. Each tablet can contain the followinginactive ingredients: colloidal silicon dioxide, croscarmellose sodium,hypromellose acetate succinate, magnesium stearate, microcrystallinecellulose, and sodium lauryl sulfate. The tablet coating can includeFD&C blue #2, hypromellose, lactose monohydrate, titanium dioxide,and/or triacetin.

It will be appreciated that use of headers in the present disclosure areprovided for the convenience of the reader. The presence and/orplacement of a header is not intended to limit the scope of the subjectmatter described herein.

EXEMPLARY EMBODIMENTS

The present disclosure also contemplates, among other things, thefollowing numbered embodiments:

-   -   1. A method of treating a patient diagnosed with a cancer        harboring a cancer cell with an IDH-1 R132 mutation selected        from the group consisting of: R132L, R132G, and R132S, the        method comprising administering to the patient in need thereof a        therapeutically effective amount of Compound 1.    -   2. The method of embodiment 1, wherein the cancer does not        harbor a IDH-2 mutation.    -   3. The method of embodiment 1, wherein the cancer does not        harbor a IDH-2 mutation selected from the group consisting of:        IDH-2 R172K and IDH-2 R140Q.    -   4. The method of embodiment 1, wherein the patient is diagnosed        as having a R132 mutation based on a patient diagnostic.    -   5. The method of embodiment 4, wherein the patient diagnostic        comprises detecting the R132 mutation in a tissue sample        obtained from the patient.    -   6. The method of embodiment 5, wherein the tissue sample is        obtained from the bone marrow of the patient.    -   7. The method of any one of embodiments 4-6, wherein the R132        mutation is detected using next generation sequencing (NGS)        without the use of PCR.    -   8. A method of treatment comprising the steps of:        -   a. selecting a patient for treatment based on the presence            of one or more IDH-1 mutations selected from the group            consisting of: R132L, R132G, and R132S;        -   b. administering Compound 1 to the selected patient from            step (a) at a starting dose of 150 mg taken orally twice            daily until disease progression or unacceptable toxicity.    -   9. The method of embodiment 8, where the IDH-1 mutation is        detected in cancer cells obtained from the blood or bone marrow        of the patient.    -   10. The method of embodiment 9, wherein the IDH-1 mutation is        detected prior to administering Compound 1 to the patient.    -   11. The method of any one of embodiments 1-10, comprising the        step of detecting the IDH-1 mutation in a cell from the patient        using a next-generation sequencing (NGS)-based tumor genotyping        assay.    -   12. The method of any one of embodiments 1-11, wherein        administration of Compound 1 to the patient results in a        decreased 2-hydroxyglutarate (2-HG) levels in the blood of the        patient within the first 15 consecutive days of treatment of the        patient with Compound 1.    -   13. The method of any one of embodiments 1-12, wherein the        method comprises administering 150 mg of Compound 1 to the        patient in the solid form obtained from the method of Example 5.    -   14. The method of any one of embodiments 1-12, wherein the        method comprises administering 150 mg of Compound 1 to the        patient twice daily throughout a course of treatment.    -   15. The method of embodiment 14, wherein the course of treatment        is at least 15 consecutive days.    -   16. The method of any one of embodiments 1-15, wherein Compound        1 is administered to the patient once every 12 hours on        consecutive days throughout a course of treatment.    -   17. The method of any one of embodiments 1-16, wherein Compound        1 is administered to the patient throughout a course of        treatment of at least 6 months.    -   18. A method of inhibiting the production of 2-HG from a cell        harboring a IHD-1 mutation selected from the group consisting        of: R132L, R132G and R132S, the method comprising contacting the        cell with Compound 1 in an amount, under conditions, and for a        time sufficient to inhibit the production of 2-HG from the cell.    -   19. A method of treating a patient diagnosed with a cancer        harboring a cancer cell with an IDH-1 R132 mutation, the method        comprising administering to the patient in need thereof a        therapeutically effective amount of Compound 1.    -   20. The method of embodiment 19, wherein the patient is        diagnosed with a cancer harboring an IDH-1 R132 mutation in a        cell obtained from the patient, prior to the administration of        Compound 1.    -   21. A method of treating a patient diagnosed with a cancer        harboring a cancer cell with an IDH-1 R132 mutation, the method        comprising administering to the patient in need thereof a        therapeutically effective amount of Compound 1.    -   22. The method of embodiment 21, wherein the patient is        diagnosed with a cancer harboring an IDH-1 R132 mutation in a        cell obtained from the patient, prior to the administration of        Compound 1.    -   23. A method of treating a patient diagnosed with a cancer, the        method comprising        -   a. diagnosing the patient as having a mutant IDH-1 mutation            in a cell obtained from the patient; and        -   b. administering a therapeutically effective amount of a            pharmaceutical composition comprising Compound 1 to the            patient in need of an inhibitor of the mutant IDH-1 enzyme            that targets the mutant IDH-1 variants R132C at no greater            than about 5 times the level of R132H; and        -   c. continuing to administer the pharmaceutical composition            to the patient throughout a course of treatment of at least            6 months.    -   24. The method of embodiment 23, wherein the patient is in need        of an inhibitor of mIDH-1 variants selected from the group        consisting of R132L, R132G, and R132S;    -   25. The method of any one of embodiments 23-24, wherein the        relative targeting of R132C and R132H variants of mIDH-1 is        measured by the ratio of IC₅₀ values obtained using the assay of        Example 3.    -   26. The method of any one of embodiments 23-25, wherein the        patient is diagnosed as having an IDH-1 mutation in a cell from        the patient using a next-generation sequencing (NGS)-based tumor        genotyping assay.    -   27. The method of any one of embodiments 23-26, wherein the        pharmaceutical composition is administered to the patient twice        per day.    -   28. The method of any one of embodiments 23-27, wherein the        pharmaceutical composition is administered to the patient in a        dose of 150 mg BID on consecutive days throughout the course of        treatment.    -   29. The method of any one of embodiments 23-28, wherein Compound        1 in the pharmaceutical composition has the solid form obtained        from Example 5.    -   30. A method of inhibiting the production of inhibiting the        production of 2-HG in a R132C mutated IDH-1 enzyme at no more        than about 5 times the inhibition of 2-HG production in a R132H        mutated IDH-1 enzyme, the method comprising contacting an IDH-1        enzyme not having arginine at position 132 with a composition        comprising Compound 1 under conditions and for a time effective        to inhibit 2-HG production in either an IDH-1 R132C or an IDH-1        R132H mutation in the mIDH-1 enzyme.    -   31. A method of treating a cancer in an adult patient, the        cancer having a known mIDH-1 frequency of about 10-90%, the        method comprising administering to a patient diagnosed with an        IDH-1 mutation comprising an IDH-1 mutation selected from the        group consisting of R132C, R132H, R132L, R132G, and R132S, the        method comprising administering to the patient in need thereof a        pharmaceutical composition comprising a total of 150 mg of a        pharmaceutically acceptable solid form of        5-{[(1S)-1-(6-chloro-2-oxo-1,2-dihydroquinolin-3-yl)ethyl]amino}-1-methyl-6-oxo-1,6-dihydropyridine-2-carbonitrile,        twice per day on consecutive days for a course of treatment        comprising 6 months.    -   32. The method of embodiment 31, wherein the patient is        diagnosed as having an IDH-1 mutation in a cell from the patient        using a next-generation sequencing (NGS)-based tumor genotyping        assay.    -   33. The method of any one of embodiments 31-32, wherein the        pharmaceutical composition is administered to the patient every        12 hours.    -   34. The method of any one of embodiments 31-33, wherein Compound        1 in the pharmaceutical composition has the solid form obtained        from Example 5.    -   35. A method of treating a chrondrosarcoma cancer having an        IDH-1 mutation in an adult patient, the method comprising        administering to the patient in need thereof a pharmaceutical        composition comprising a total of 150 mg of a pharmaceutically        acceptable solid form of        5-{[(1S)-1-(6-chloro-2-oxo-1,2-dihydroquinolin-3-yl)ethyl]amino)}-1-methyl-6-oxo-1,6-dihydropyridine-2-carbonitrile,        twice per day on consecutive days for a course of treatment        comprising 6 months.    -   36. The method of embodiment 35, wherein the patient is        diagnosed as having an IDH-1 mutation in a cell from the patient        using a next-generation sequencing (NGS)-based tumor genotyping        assay.    -   37. The method of any one of embodiments 35-36, wherein the        pharmaceutical composition is administered to the patient every        12 hours.    -   38. A method of treating a patient diagnosed with a form of        cancer characterized by an IDH1 mutation selected from the group        consisting of R132G, R132S and R132L, the method comprising        orally administering a total of 150 mg of Compound 1 twice per        day (e.g. only twice per day) to the patient in need thereof:

-   -   39. The method of embodiment 38, wherein the patient is        diagnosed with a cancer characterized by a concurrent mutation        selected from the group consisting of FLT3, NPM1, CEBPA and        TP53.    -   40. The method of embodiment 38, wherein the patient is        diagnosed with a cancer that is not characterized by an IDH2        mutation.    -   41. The method of embodiment 38, wherein the patient is        diagnosed with acute myeloid leukemia (AML) or myelodysplastic        syndrome (MDS) characterized by the IDH1 mutation.    -   42. The method of embodiment 41, wherein the patient is        diagnosed with MDS or AML further characterized by a concurrent        mutation selected from the group consisting of FLT3, NPM1, CEBPA        and TP53.    -   43. The method of embodiment 38, wherein the patient is        diagnosed with a cancer characterized by a concurrent mutation        selected from the group consisting of DNMT3A, NPM1, SRSF2, NRAS,        RUNX1, ASXL1, FLT3, STAG2, TET2, SMC1A, SF3B1, U2AF1, PHF6,        JAK2, MPL, NF1, ASXL2, BCOR, EED, WT1, CBL, CSF3R, ETNK1,        PTPN11, ATM and TP53.    -   44. A method of treating a patient diagnosed with a        hematological malignancy characterized by an IDH1 mutation        selected from the group consisting of R132C, R123H, R132G, R132S        and R132L and a concurrent FLT3 mutation, the method comprising        administering a total of 150 mg of Compound 1 orally twice per        day (e.g. only twice per day) to the patient in need thereof:

-   -   45. The method of embodiment 44, wherein the patient is        diagnosed with a hematological malignancy characterized by a        co-mutation selected from the group consisting of DNMT3A, NPM1,        SRSF2, NRAS, RUNX1, ASXL1, STAG2, TET2, SMC1A, SF3B1, U2AF1,        PHF6, JAK2, MPL, NF1, ASXL2, BCOR, EED, WT1, CBL, CSF3R, ETNK1,        PTPN11, ATM and TP53.    -   46. The method of embodiment 44, comprising administering        Compound 1 to the patient every day for 6 months.    -   47. The method of embodiment 44, wherein Compound 1 is        administered to the patient as a single agent for the treatment        of AML.    -   48. The method of embodiment 44, wherein Compound 1 is        administered to the patient in combination with azacitidine        during one or more 28-day treatment cycles, wherein        -   a. the azacitidine is administered to the patient at the            dose of 75 mg/m² for 7 days IV/SC per every 28-day cycle;            and        -   b. a total of 150 mg of Compound 1 is administered to the            patient twice per day throughout the 28-day treatment            cycles.    -   49. The method of embodiment 44, wherein the patient does not        have an IDH-2 mutation.    -   50. A method of treating a patient diagnosed with a form of        cancer characterized by an IDH1 mutation selected from the group        consisting of R132G, R132S and R132L, the method comprising        orally administering to the patient in need thereof a total        amount of 150 mg of Compound 1 BID to the patient in need        thereof:

-   -   -   each day for a total of at least 6 months to treat the            cancer characterized by the IDH1 mutation.

    -   51. The method of embodiment 50, wherein the patient is        diagnosed with a cancer characterized by a concurrent FLT3        mutation.

    -   52. The method of embodiment 50, wherein the patient is        diagnosed with a cancer characterized by a concurrent NPM1        mutation.

    -   53. The method of embodiment 50, wherein the patient is        diagnosed with a cancer characterized by a concurrent CEBPA        mutation.

    -   54. The method of embodiment 50, wherein the patient is        diagnosed with a cancer characterized by a concurrent TP53        mutation.

    -   55. The method of embodiment 50, wherein the patient is        diagnosed with a cancer further characterized by both the mIDH1        mutation and a co-mutation selected from the group consisting of        DNMT3A, NPM1, SRSF2, NRAS, RUNX1, ASXL1, STAG2, TET2, SMC1A,        SF3B1, U2AF1, PHF6, JAK2, MPL, NF1, ASXL2, BCOR, EED, WT1, CBL,        CSF3R, ETNK1, PTPN11, ATM and TP53.

    -   56. The method of embodiment 51, wherein Compound 1 is        administered as a single agent without azacitidine.

    -   57. The method of embodiment 51, wherein Compound 1 is        administered in combination with azacitidine to treat the mIDH1        cancer.

The present disclosure contemplates, among other things, the followingnumbered embodiments:

-   -   1. A method of treating a patient diagnosed with        relapsed/refractory mIDH1 gliomas comprising a step of        administering to the patient in need thereof a total of 150 mg        of olutasidenib twice per day (BID).    -   2. The method of embodiment 1, wherein the olutasidenib is        administered orally.    -   3. The method of any one of embodiments 1-2, wherein the        olutasidenib is administered to the patient in need thereof        without administration of azacitidine.    -   4. The method of embodiment 3, wherein the olutasidenib is        administered as a single agent to treat the relapsed/refractory        mIDH1 glioma in the patient.    -   5. The method of embodiment 1 or embodiment 2, wherein the        olutasidenib is administered to the patient in need thereof in        combination with administration of azacitidine to treat the        relapsed/refractory mIDH1 glioma in the patient.    -   6. The method of any one of embodiments 1-5, wherein the patient        has previously received temozolomide to treat the mIDH1 glioma        in the patient, prior to administration of the olutasidenib to        the patient.    -   7. The method of any one of embodiments 1-4, wherein the        olutasidenib is administered to the patient daily throughout a        course of treatment having a duration of at least 0.2 months.    -   8. The method of embodiment 7, wherein the duration of treatment        is between 0.2-11.4 months.    -   9. The method of any one of embodiments 1-4, wherein the        olutasidenib is administered to the patient daily throughout a        course of treatment having a duration of at least 1 month.    -   10. The method of embodiment 9, wherein the duration of        treatment is 1-12 months.    -   11. The method of embodiment 9, wherein the duration of        treatment is 1-11.4 months.    -   12. The method of embodiment 9, wherein the duration of        treatment is one year.    -   13. The method of embodiment 5 or embodiment 6, wherein the        olutasidenib is administered to the patient daily throughout a        course of treatment having a duration of at least 0.2 months.    -   14. The method of embodiment 9, wherein the duration of        treatment is 0.2-2.3 months.    -   15. The method of embodiment 9, wherein the duration of        treatment is 1-3 months.    -   16. A method of treating a patient diagnosed with        relapsed/refractory mIDH1 solid tumors comprising the step of        administering to the patient in need thereof a total of 150 mg        of olutasidenib twice per day (BID).    -   17. The method of embodiment 16, wherein the olutasidenib is        administered orally.    -   18. The method of embodiment 16 or embodiment 17, wherein the        patient is diagnosed with a mIDH1 solid tumor is selected from        the group consisting of intrahepatic cholangiocarcinoma (IHCC)        and chondrosarcoma (CS).    -   19. The method of embodiment 18, wherein the patient is        diagnosed with a mIDH1 intrahepatic cholangiocarcinoma (IHCC)        solid tumor.    -   20. The method of embodiment 18, wherein the patient is        diagnosed with a mIDH1 chondrosarcoma (CS) solid tumor.    -   21. The method of any one of embodiments 1-20, wherein the        patient has a mIDH1 tumor having a mutation selected from the        group consisting of: R132C, R132G, R132S, R132H, and R132L.

The present disclosure contemplates, among other things, the followingnumbered embodiments:

1. A method of treating a patient diagnosed with a cancer characterizedby (i) an IDH-1 mutation selection from R132G, R132S, and R132L and (ii)a mutation selected from DNMT3A, NPM1, SRSF2, NRAS, RUNX1, ASXL1, FLT3,STAG2, TET2, SMC1A, SF3B1, U2AF1, PHF6, JAK2, MPL, NF1, ASXL2, BCOR,EED, WT1, CBL, CSF3R, ETNK1, PTPN11, ATM and TP53, the method comprisingorally administering 150 mg of Compound 1:

twice daily to the patient in need thereof.2. The method of embodiment 1, wherein the cancer is not characterizedby an IDH2 mutation.3. The method of embodiment 1 or 2, wherein the cancer is characterizedby a mutation selected from FLT3, NPM1, CEBPA and TP53.4. The method of any one of embodiments 1-3, wherein the cancer ischaracterized by a mutation selected from DNMT3A, TP53, ATM, and NRAS.5. The method of any one of embodiments 1-4, wherein the cancer is acutemyeloid leukemia or myelodysplastic syndrome.6. The method of any one of embodiments 1-4, wherein the cancer isglioma.7. The method of any one of embodiments 1-6, wherein Compound 1 isadministered to the patient every day for at least 6 months.8. The method of any one of embodiments 1-7, wherein Compound 1 isadministered as a single agent.9. The method of any one of embodiments 1-7, wherein Compound 1 isadministered to the patient in combination with azacitidine during oneor more 28-day treatment cycles, wherein:

-   -   a. the azacitidine is administered to the patient at the dose of        75 mg/m² for 7 days IV/SC per every 28-day cycle; and    -   b. a total of 150 mg of Compound 1 is administered BID to the        patient every day throughout the one or more 28-day treatment        cycles.        10. A method of treating a patient diagnosed with a        hematological malignancy characterized by (i) at least one IDH1        mutation selected from R132C, R132H, R132G, R132S, and R132L        and (ii) at least one mutation selected from CEBPA, DNMT3A,        NPM1, SRSF2, NRAS, RUNX1, ASXL1, FLT3, STAG2, TET2, SMC1A,        SF3B1, U2AF1, PHF6, JAK2, MPL, NF1, ASXL2, BCOR, EED, WT1, CBL,        CSF3R, ETNK1, PTPN11, ATM and TP53, the method comprising orally        administering 150 mg of Compound 1:

as a single agent twice daily to the patient in need thereof.11. The method of embodiment 10, wherein the hematological malignancy iswith acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS).12. The method of embodiment 10 or 11, wherein the hematologicalmalignancy is characterized by at least one IDH1 mutation selected fromR132G, R132S, and R132L.13. The method of any one of embodiments 10-12, wherein thehematological malignancy is not characterized by an IDH2 mutation.14. The method of any one of embodiments 10-13, wherein thehematological malignancy is characterized by at least one mutationselected from FLT3, NPM1, CEBPA and TP53.12. A method of treating a patient diagnosed with glioma characterizedby (i) at least one IDH1 mutation selected from R132C, R132H, R132G,R132S, and R132L and (ii) at least one mutation selected from DNMT3A,TP53, ATM, and NRAS, the method comprising orally administering 150 mgof Compound 1:

twice daily to the patient in need thereof.13. The method of embodiment 12, wherein the glioma is characterized byat least one IDH1 mutation selected from R132G, R132S, and R132L.14. The method of embodiment 12 or 13, wherein the glioma is notcharacterized by an IDH2 mutation.15. The method of any one of embodiments 12-14, wherein Compound 1 isadministered as a single agent for treatment of glioma.16. The method of any one of embodiments 12-15, wherein Compound 1 isadministered to the patient every day for at least 6 months.17. A method of treating a patient diagnosed with a hematologicalmalignancy characterized by (i) at least one IDH1 mutation selected fromR132C, R132H, R132G, R132S, and R132L and (ii) at least one mutationselected from CEBPA, DNMT3A, NPM1, SRSF2, NRAS, RUNX1, ASXL1, STAG2,TET2, SMC1A, SF3B1, U2AF1, PHF6, JAK2, MPL, NF1, ASXL2, BCOR, EED, WT1,CBL, CSF3R, ETNK1, PTPN11, ATM and TP53, the method comprising orallyadministering 150 mg of Compound 1:

twice daily in combination with azacitidine to the patient in needthereof.18. The method of embodiment 17, wherein the hematological malignancy ischaracterized by at least one mutation selected from NPM1, SRSF2, RUNX1,ASXL1, STAG2, TET2, SMC1A, SF3B1, U2AF1, PHF6, JAK2, MPL, NF1, ASXL2,EED, WT1, CBL, CSF3R, ETNK1, PTPN11, ATM and TP53.

-   -   19. The method of embodiment 17 or 18, wherein the hematological        malignancy is with acute myeloid leukemia (AML) or        myelodysplastic syndrome (MDS).        20. The method of any one of embodiments 17-19, wherein the        hematological malignancy is characterized by at least one IDH1        mutation selected from R132G, R132S, and R132L.        21. The method of any one of embodiments 17-20, wherein the        hematological malignancy is not characterized by an IDH2        mutation.        22. The method of any one of embodiments 17-21, wherein Compound        1 is administered to the patient in combination with azacitidine        during one or more 28-day treatment cycles, wherein:    -   a. the azacitidine is administered to the patient at the dose of        75 mg/m² for 7 days IV/SC per every 28-day cycle; and    -   b. a total of 150 mg of Compound 1 is administered BID to the        patient every day throughout the one or more 28-day treatment        cycles.

The present disclosure contemplates, among other things, the followingnumbered embodiments:

-   -   1. A method of treating AML or MDS in a patient harboring        isocitrate dehydrogenase 1 mutations (mIDH-1), the method        comprising administering to a patient in need thereof a        therapeutically effective amount of a R132X mIDH-1 Selective        Inhibitor Therapy consisting of Compound 1 in an oral dosage        form for a course of treatment starting with the initial        administration of Compound 1 and continuing on consecutive days        for at least 15 days, wherein the administration of the        therapeutically effective amount of Compound 1 results in the        patient having a durable therapeutically effective trough blood        plasma concentration of Compound 1 in the patient throughout the        course of treatment.    -   2. A method of treating AML or MDS in a patient harboring        isocitrate dehydrogenase 1 mutations (mIDH-1), the method        comprising administering to a patient in need thereof a        therapeutically effective amount of Compound 1 for at least        three consecutive treatment cycles of 28 consecutive days each,        wherein the administration of the therapeutically effective        amount of Compound 1 results in the patient having both:    -   a. a durable sustained therapeutically effective trough blood        plasma concentration of Compound 1 in the patient throughout the        course of treatment, and    -   b. a reduced level of 2-HG in the patient's plasma after the        first two consecutive treatment cycles.    -   3. The method of any one of embodiments 1 or 2, wherein    -   a. the steady state blood plasma concentration of Compound 1 in        the patient is maintained at or above about 2,000 ng/mL        throughout the course of treatment, and    -   b. the level of 2-HG in the patient plasma is maintained at or        below about 200 ng/mL after the start of the third consecutive        treatment cycle of the course of treatment on day 15 after the        initial dose of Compound 1.    -   4. The method of any one of embodiments 1-3, wherein the        Compound 1 is administered in a dose of 150 mg/day twice per day        throughout the course of treatment.    -   5. The method of any one of embodiments 1-4, wherein the        Compound 1 is administered with food to improve bioavailability        of Compound 1.    -   6. The method of any one of embodiments 1-5, wherein the course        of treatment is 12-30 weeks.    -   7. The method of any one of embodiments 1-6, wherein the method        further comprises the administration of azacitidine to the        patient throughout the course of treatment.    -   8. The method of any one of embodiments 1-6, wherein the patient        is receiving or previously received treatment with azacitidine.    -   9. The method of embodiment 7 or 8, wherein the azacitidine is        subcutaneously or intravenously administered to the patient in        an azacitidine treatment cycle consisting of the administration        of a total dose of 75 mg/m² each day for 7 consecutive days        beginning at the start of each treatment cycle, followed 21        consecutive days without administration of the azacitidine to        the patient.    -   10. The method of any one of embodiments 1-6, wherein the method        further comprises the administration of cytarabine to the        patient throughout the course of treatment.    -   11. The method of any one of embodiments 1-6, wherein the        patient is receiving or previously received treatment with        cytarabine.    -   12. The method of embodiment 10 or 11, wherein the cytarabine is        subcutaneously or intravenously administered to the patient in a        cytarabine treatment cycle consisting of the administration of a        total dose of 20 mg/day each day for 7 consecutive days        beginning at the start of each treatment cycle, followed 10        consecutive days without administration of the cytarabine to the        patient.    -   13. The method of any one of embodiment 1-12, wherein the        patient has been identified as having a R132X mutation in mIDH-1        using a diagnostic method comprising a next generation        sequencing (NGS) analysis of a bone marrow or other tissue        sample from the patient obtained prior to the administration of        Compound 1 to the patient.    -   14. The method of any one of embodiments 1-13, wherein the        subject has relapsed or refractory (R/R) AML.    -   15. The method of any one of embodiments 1-13, wherein the        subject has AML or MDS with residual R132X mIDH-1 in morphologic        complete remission or complete remission with incomplete blood        count recovery (CR/CRi) after cytotoxic-containing induction        therapy with residual IDH-R132X mutation.    -   16. The method of any one of embodiments 1-13, wherein the        subject has relapsed or refractory AML or MDS previously treated        with an IDH1 inhibitor.    -   17. The method of any one of embodiments 1-13, wherein the        subject has relapsed or refractory AML or MDS that are naïve to        prior hypomethylating therapy and IDH1 inhibitor therapy    -   18. The method of any one of embodiments 1-13, wherein the        subject has relapsed or refractory AML or MDS that has        inadequately responded or has progressed immediately preceding        hypomethylating therapy.    -   19. The method of any one of embodiments 1-13, wherein the        subject is a subject with relapsed or refractory AML or MDS that        have been previously treated with single-agent IDH1 inhibitor        therapy as their last therapy prior to study enrollment.    -   20. The method of any one of embodiments 1-19, wherein the        subject has been diagnosed with AML with a R132X mIDH-1.    -   21. The method of any one of embodiments 1-19, wherein the        subject has MDS with AML with a R132X mIDH-1.    -   22. The method of any one of embodiments 1-21, wherein the        subject has been diagnosed with a R132X mIDH-1 selected from the        group consisting of R132H, R132C or both R132H and R132C.    -   23. A method of treating AML or MDS in a patient harboring at        least one R132X isocitrate dehydrogenase 1 mutation (mIDH-1),        the method comprising administering to the patient in need        thereof a R132X mIDH-1 Selective Inhibitor Therapy consisting of        150 mg BID of Compound 1 in an pharmaceutically acceptable oral        dosage form for a course of treatment starting with the initial        administration of Compound 1 and continuing on consecutive days        for at least 15 days.    -   24. The method of embodiment 23, wherein the course of treatment        comprises at least 4 consecutive treatment cycles each        consisting of 28 consecutive days of administering Compound 1 to        the patient twice per day.    -   25. The method of embodiment 23, wherein the course of treatment        comprises 12-30 weeks of consecutive days of administering        Compound 1 to the patient twice per day.    -   26. A method of treating AML or MDS in a patient harboring at        least one R132X isocitrate dehydrogenase 1 mutation (mIDH-1),        the method comprising administering to the patient 150 mg BID of        Compound 1 in a pharmaceutically acceptable oral dosage form for        a course of treatment starting with the initial administration        of Compound 1 and continuing on consecutive days for at least 15        days.    -   27. A method of treating AML or MDS in a patient harboring at        least one R132X isocitrate dehydrogenase 1 mutation (mIDH-1),        the method comprising administering to the patient 150 mg BID of        Compound 1 in a pharmaceutically acceptable oral dosage form for        a course of treatment starting with the initial administration        of Compound 1 and continuing on consecutive days for at least 12        weeks.    -   28. A method of treating AML or MDS in a patient harboring at        least one R132X isocitrate dehydrogenase 1 mutation (mIDH-1),        the method comprising administering to the patient 150 mg BID of        Compound 1 in a pharmaceutically acceptable oral dosage form for        a course of treatment starting with the initial administration        of Compound 1 and continuing on consecutive days for at least 30        weeks.    -   29. A method of treating AML or MDS in a patient harboring one        or more R132X isocitrate dehydrogenase 1 mutations (mIDH-1), the        method comprising administering to a patient in need thereof a        therapeutically effective amount of a R132X mIDH-1 Selective        Inhibitor Therapy consisting of Compound 1 in an oral dosage        form for a course of treatment starting with the initial        administration of Compound 1 and continuing on consecutive days        for at least 15 days, wherein the administration of the        therapeutically effective amount of Compound 1 results in the        patient having both:    -   a. a durable trough blood plasma concentration of Compound 1 in        the patient measured at or above the IC90 concentration of        Compound 1 for 2-HG suppression of the R132X mIDH-1 throughout        the course of treatment, and    -   b. a level of 2-HG in the patient's plasma of less than about        200 ng/mL within two initial consecutive treatment cycles that        is maintained throughout the course of treatment.    -   30. The method of embodiment 29, wherein course of treatment is        at least 3 consecutive 28-day treatment cycles.    -   31. The method of embodiments 29 or 30, wherein the trough blood        plasma concentration of Compound 1 in the patient is measured        between 2,000 ng/mL-7,200 ng/mL.    -   32. The method of any one of embodiments 29-31, wherein the        level of 2-HG is maintained at about 180 ng/mL in the blood        plasma of the patient throughout the course of treatment after        the first 15 consecutive days of administering Compound 1 to the        patient.    -   33. The method of any one of embodiments 1-32, wherein the        concentration of Compound 1 measured in the blood of the patient        does not decline more than 20% throughout the course of        treatment compared to the steady state blood concentration of        Compound 1 measured prior to administration of Compound 1 at        cycle 2, day 1 (day 29).    -   34. The method of any one of embodiments 1-32, wherein the        concentration of Compound 1 measured in the blood of the patient        does not decline more than 10% throughout the course of        treatment compared to the steady state blood concentration of        Compound 1 measured prior to administration of Compound 1 at        cycle 2, day 1 (day 29).    -   35. The method of any one of embodiments 33 and 34, wherein the        course of treatment is a total of 12 weeks.    -   36 The method of any one of embodiments 33 and 34, wherein the        course of treatment is a total of 30 weeks.    -   37. The method of any one of embodiments 22-36, wherein the        subject has been diagnosed with a R132X mIDH-1 selected from the        group consisting of R132H, R132C or both R132H and R132C.    -   38. The method of any one of embodiments 1-37, wherein Compound        1 is administered in the pharmaceutically acceptable dosage form        obtainable from Step 6 of Example 5.    -   39. A method of treating AML in a patient harboring at least one        R132X isocitrate dehydrogenase 1 mutation (mIDH-1) selected from        the group consisting of: R132C, R132H, R132S, R132G, and R132L,        wherein the method comprises administering to the patient 150 mg        BID of Compound 1 in a pharmaceutically acceptable oral dosage        form for a course of treatment starting with the initial        administration of Compound 1 and continuing for at least 28        consecutive days.    -   40. A method of treating AML in a patient harboring one or more        R132X isocitrate dehydrogenase 1 mutations (mIDH-1) selected        from the group consisting of: R132C, R132H, R132S, R132G, and        R132L, wherein the method comprises administering to a patient        in need thereof a therapeutically effective amount of a R132X        mIDH-1 Selective Inhibitor Therapy consisting of Compound 1 in        an oral dosage form for a course of treatment starting with the        initial administration of Compound 1 and continuing for at least        15 consecutive days, wherein the administration of the        therapeutically effective amount of Compound 1 results in the        patient having a durable trough blood plasma concentration of        Compound 1 in the patient measured at or above the IC90        concentration of Compound 1 for 2-HG suppression of the R132X        mIDH-1 throughout the course of treatment.    -   41. The method of embodiment 40, wherein the administration of        the therapeutically effective amount of Compound 1 results in        the patient having a level of 2-HG in the patient's plasma of        less than about 200 ng/mL within two initial consecutive        treatment cycles that is maintained throughout the course of        treatment.    -   42. A method of treating AML in a patient harboring one or more        R132X isocitrate dehydrogenase 1 mutations (mIDH-1) selected        from the group consisting of: R132C, R132H, R132S, R132G, and        R132L, wherein the method comprises administering to a patient        in need thereof a therapeutically effective amount of a R132X        mIDH-1 Selective Inhibitor Therapy consisting of Compound 1 in        an oral dosage form for a course of treatment starting with the        initial administration of Compound 1 and continuing for at least        15 consecutive days, wherein the administration of the        therapeutically effective amount of Compound 1 results in the        patient having a level of 2-HG in the patient's plasma of less        than about 200 ng/mL within two initial consecutive treatment        cycles that is maintained throughout the course of treatment.    -   43. The method of embodiment 42, wherein the administration of        the therapeutically effective amount of Compound 1 results in        the patient having a durable trough blood plasma concentration        of Compound 1 in the patient measured at or above the IC90        concentration of Compound 1 for 2-HG suppression of the R132X        mIDH-1 throughout the course of treatment.    -   44. A method of treating AML in a patient harboring one or more        R132X isocitrate dehydrogenase 1 mutations (mIDH-1) selected        from the group consisting of: R132C, R132H, R132S, R132G, and        R132L, the method comprising administering to a patient in need        thereof a therapeutically effective amount of a R132X mIDH-1        Selective Inhibitor Therapy consisting of Compound 1 in an oral        dosage form for a course of treatment starting with the initial        administration of Compound 1 and continuing for at least 15        consecutive days, wherein the administration of the        therapeutically effective amount of Compound 1 results in the        patient having a durable trough blood plasma concentration of        Compound 1 in the patient measured at or above 2,000 ng/mL        throughout the course of treatment of at least 6 months.    -   45. The method of embodiment 44, wherein the administration of        the therapeutically effective amount of Compound 1 results in        the patient having a level of 2-HG in the patient's plasma of        less than about 200 ng/mL within two initial consecutive 28-day        treatment cycles and is maintained throughout the course of        treatment.    -   44. A method of treating AML in a patient harboring one or more        R132X isocitrate dehydrogenase 1 mutations (mIDH-1) selected        from the group consisting of: R132C, R132H, R132S, R132G, and        R132L, wherein the method comprises administering to a patient        in need thereof:    -   a. a therapeutically effective amount of Compound 1 in an oral        dosage form for a Course of Treatment starting with the initial        administration of Compound 1 and continuing for at least 15        consecutive days for one or more consecutive R132X mIDH-1        Selective Inhibitor 28-day Treatment Cycles, wherein Compound 1        is the only R132X mIDH-1 selective inhibitor administered to the        patient during the Course of Treatment; and    -   b. azacitidine subcutaneously or intravenously administered to        the patient throughout the one or more R132X mIDH-1 Selective        Inhibitor 28-day Treatment Cycle(s), in an azacitidine treatment        cycle consisting of the administration of a total dose of 75        mg/m² each day for 7 consecutive days beginning at the start of        each treatment cycle, followed 21 consecutive days without        administration of the azacitidine to the patient;    -   wherein the administration of the therapeutically effective        amount of Compound 1 results in the patient having a durable        trough blood plasma concentration of Compound 1 in the patient        that is no less than about 90% of the concentration of Compound        1 measured after the first 15 days of the first R132X mIDH-1        Selective Inhibitor 28-day Treatment Cycle, throughout the        Course of Treatment of at least 6 months.    -   45. A method of treating an adult patient diagnosed with a        mutant IDH-1 form of AML, comprising administering to the        patient in need thereof a combination therapy throughout a        Course of Treatment lasting at least 6 months, wherein the        combination therapy comprises a combination of:    -   a. 150 mg BID of Compound 1 each day throughout a Course of        Treatment of at least 6 months, wherein the Compound 1 is the        only mutant IDH-1 inhibitor administered to the patient during        the Course of Treatment;    -   b. azacitidine subcutaneously or intravenously administered to        the patient throughout the Course of Treatment at a total dose        of 75 mg/m² each day for 7 consecutive days beginning at the        start of each treatment cycle, followed 21 consecutive days        without administration of the azacitidine to the patient.    -   46. A method of treating an adult patient diagnosed with a        mutant IDH-1 form of AML, comprising administering to the        patient in need thereof 150 mg BID of Compound 1 each day        throughout a Course of Treatment of at least 6 months, in        combination with azacitidine for the treatment of the AML in the        adult patient, wherein Compound 1 is the only mutant IDH-1        inhibitor targeting R132C, R132H, R132S, R132G, or R132L        variants of IDH-1 that is administered to the patient during the        Course of Treatment.    -   47. The method of embodiment 46, wherein the azacitidine is        administered subcutaneously or intravenously to the patient        throughout the Course of Treatment at a total dose of 75 mg/m²        each day for 7 consecutive days beginning at the start of each        treatment cycle, followed 21 consecutive days without        administration of the azacitidine to the patient.

The present disclosure also contemplates, among other things, thefollowing numbered embodiments:

-   -   1. A method of treating a patient harboring one or more R132X        isocitrate dehydrogenase 1 mutations (mIDH-1), the method        comprising administering to the patient in need thereof a R132X        mIDH-1 Selective Inhibitor Therapy consisting of the oral        administration of Compound 1 to the patient at a dose of 150 mg        twice per day (BID) for a Course of Treatment starting with the        initial administration of Compound 1 and continuing on        consecutive days for at least 15 days.    -   2. The method of embodiment 1, wherein Compound 1 is        administered with food to improve bioavailability of Compound 1.    -   3. The method of any one of embodiments 1-2, wherein the Course        of Treatment is at least 12 weeks.    -   4. The method of any one of embodiments 1-2, wherein the Course        of Treatment is at least 20 weeks.    -   5. The method of any one of embodiments 1-2, wherein the Course        of Treatment is at least 30 weeks.    -   6. The method of any one of embodiments 1-2, wherein the Course        of Treatment is at least 6 months.    -   7. The method of any one of embodiments 1-6, wherein the subject        has a R132X mIDH-1 selected from the group consisting of R132H,        R132C or both R132H and R132C.    -   8. The method of any one of embodiments 1-7, wherein Compound 1        is administered in the solid form obtained from Example 5.    -   9. A method of treatment of a disease in a patient harboring a        mIDH-1 mutation, the method comprising the steps of:        -   a. selecting a patient for treatment based on the presence            of an IDH-1 mutation detected in cells obtained from the            patient;        -   b. administering Compound 1 to the selected patient from            step (a) at a starting dose of 150 mg taken orally twice            daily until disease progression or unacceptable toxicity.    -   10. The method of embodiment 9, further comprising administering        Compound 1 to the selected patient for at least 6 months.    -   11. The method of any one of embodiments 9-10, wherein Compound        1 is administered to the patient as a single agent or in        combination with other therapeutic agents.    -   12. The method of any one of embodiments 9-11, further        comprising assessing blood counts and blood chemistries of the        selected patient for leukocytosis and tumor lysis syndrome prior        to the initiation of Compound 1 in step (b).    -   13. The method of any one of embodiments 9-12, further        comprising the step (c) of monitoring a selected patient at a        minimum of every 2 weeks for at least the first 3 months during        treatment of the patient with compound 1 according to step (b).    -   14. The method of any one of embodiments 9-13, wherein Compound        1 is administered in the solid form obtained from Example 5 in a        pharmaceutically acceptable oral dosage form.    -   15. The method of any one of embodiments 9-14 wherein the        patient is selected for treatment based on the detection of one        or more R132X IDH-1 mutations in cells obtained from the        patient.    -   16. The method of embodiment 15, wherein the R132X IDH-1        mutation is detected using next generation sequencing of patient        bone marrow tissue.    -   17. The method of any one of embodiments 15-16, wherein the        R132X mutation is selected from the group consisting of R132H        and R132C.    -   18. The method of any one of embodiments 16-17, wherein the        R132X IDH-1 mutation is detected prior to the administration of        Compound 1.    -   19. A method of treating a patient harboring one or more R132X        isocitrate dehydrogenase 1 mutations (mIDH-1), the method        comprising orally administering to the patient 150 mg of an oral        pharmaceutical dosage form of the compound        5-{[(1S)-1-(6-chloro-2-oxo-1,2-dihydroquinolin-3-yl)ethyl]amino}-1-methyl-6-oxo-1,6-dihydropyridine-2-carbonitrile        twice per day (BID) on consecutive days for at least 15 days.    -   20. The method of embodiment 19, wherein the oral pharmaceutical        dosage form is the solid form of Compound 1 obtained by the        process of Example 5.    -   21. The method of any one of embodiments 19-20, wherein the        R132X mutation is selected from the group consisting of R132H        and R132C.    -   22. The method of any one of embodiments 19-21, wherein the        compound is administered to the patient on consecutive days for        at least 20 weeks.    -   23. The method of any one of embodiments 19-22, wherein the        compound is administered to the patient on consecutive days for        at least 30 weeks.    -   24. The method of any one of embodiments 19-23, further        comprising detection of the R132X IDH-1 mutation in the patient        using next generation sequencing of patient bone marrow tissue        prior to the administration of the compound to the patient.    -   25. A method of treatment comprising orally administering to a        patient harboring a R132X mIDH-1 arginine mutation a dose of 150        mg BID of a pharmaceutically acceptable solid form of compound        of formula (I) as obtained from Example 5

-   -   26. The method of embodiment 25, wherein the pharmaceutically        acceptable solid form of Compound 1 is administered to the        patient on consecutive days for at least 20 weeks.    -   27. The method of embodiment 25, wherein the pharmaceutically        acceptable solid form of Compound 1 is administered to the        patient on consecutive days for at least 30 weeks.    -   28. The method of embodiment 25, wherein the pharmaceutically        acceptable solid form of Compound 1 is administered to the        patient on consecutive days for at least 6 months.    -   29. The method of any one of embodiments 25-28, wherein Compound        1 is administered to the patient as a single agent or in        combination with other therapeutic agents.    -   30. The method of any one of embodiments 25-29, wherein the        R132X mIDH-1 arginine mutation is selected from the group        consisting of: R132H, R132C, R132G, R132L, and R132S.    -   31. The method of any one of embodiments 25-30, further        comprising detection of the R132X IDH-1 arginine mutation in the        patient using next generation sequencing of patient bone marrow        tissue prior to the administration of Compound 1 to the patient.    -   32. The method of any one of embodiments 1-31, wherein the        patient has not received another mIDH-1 inhibitor compound.    -   33. The method of any one of embodiments 1-8, wherein the        patient has greater than 200 ng/mL of 2-HG prior to initiating        the R132X mIDH-1 Selective Inhibitor Therapy.    -   34. The method of any one of embodiments 9-18, wherein the        patient selected in step (a) has greater than 200 ng/mL of 2-HG        prior to administering Compound 1 in step (b).    -   35. The method of any one of embodiments 19-24, wherein the        patient has greater than 200 ng/mL of 2-HG prior to        administration of the oral pharmaceutical dosage form of the        compound to the patient.    -   36. The method of any one of embodiments 25-31, wherein the        patient has greater than 200 ng/mL of 2-HG prior to        administration of the compound of formula (I) to the patient.    -   37. A method of treatment comprising orally administering to a        patient having elevated blood levels of 2-HG greater than about        200 ng/mL and harboring at least one of a R132H, R132C, R132G,        R132L, and R132S IDH-1 mutation, a dose of 150 mg BID each day        of a pharmaceutically acceptable solid form of compound of        formula (I) as obtained from Example 5

on consecutive days for at least 15 days.

-   -   38. The method of embodiment 37, wherein the pharmaceutically        acceptable solid form of Compound 1 is administered to the        patient on consecutive days for at least 20 weeks.    -   39. The method of embodiment 37, wherein the pharmaceutically        acceptable solid form of Compound 1 is administered to the        patient on consecutive days for at least 30 weeks.    -   40. The method of embodiment 37, wherein the pharmaceutically        acceptable solid form of Compound 1 is administered to the        patient on consecutive days for at least 6 months.    -   41. A method of treating a patient diagnosed with a cancer        harboring one or more R132X isocitrate dehydrogenase 1 mutations        (mIDH-1) selected from the group consisting of R132C, R132H,        R132L, R132G, and R132S, the method comprising the oral        administration of Compound 1 as the only inhibitor of mIDH-1 to        the patient, at a total dose of 150 mg twice per day (BID)        throughout a Course of Treatment starting with the initial        administration of Compound 1 and continuing on consecutive days        for at least 6 months.    -   42. A method of treating an adult patient diagnosed with a        cancer harboring one or more R132X isocitrate dehydrogenase 1        mutations (mIDH-1) selected from the group consisting of R132C,        R132H, R132L, R132G, and R132S, the method comprising the oral        administration of a total dose of 150 mg twice per day (BID) of        Compound 1 in the solid form obtained from Example 5, on        consecutive days throughout a Course of Treatment starting with        the initial administration of Compound 1 and continuing on        consecutive days for at least 6 months, wherein Compound 1 is        the only inhibitor of mIDH-1 administered to the patient during        a Course of Treatment.    -   43. The method of any one of embodiments 41-42, further        comprising the administration of an hypomethylating agent to the        patient during the Course of Treatment.

The present disclosure also contemplates, among other things, thefollowing numbered embodiments:

-   -   1. A method of treating a patient diagnosed with a glioma cancer        harboring a cancer cell with an IDH-1 R132 mutation, the method        comprising administering to the patient in need thereof a        therapeutically effective amount of Compound 1 and a        hypomethylating agent over a course of treatment comprising        multiple 28-day treatment cycles.    -   2. A method of treatment comprising the steps of:

-   a. selecting a patient diagnosed with a glioma cancer harboring an    IDH-1 mutation;

-   b. administering Compound 1 to the selected patient from step (a) at    a starting dose of 150 mg taken orally twice daily for a treatment    cycle of 28 consecutive days; and

-   c. administering azacitidine subcutaneously or intravenously to the    patient during the same treatment cycle as step (b), in a total dose    of 75 mg/m2 each day for the first 7 consecutive days of the    treatment cycle followed by 21 consecutive days without the    administration of azacitidine until the end of the treatment cycle,    with the exception of optionally permitting a 48-hour dose    interruption of azacitidine on a weekend of holiday during the    treatment cycle.    -   3. The method of any one of embodiments 1-2, wherein the cancer        does not harbor a IDH-2 mutation.    -   4. The method of any one of embodiments 1-3, wherein the patient        has been diagnosed as having a R132 mutation based on a patient        diagnostic.    -   5. The method of embodiment 4, wherein the patient diagnostic        comprises detecting the R132 mutation in a biological sample        obtained from the patient.    -   6. The method of embodiment 5, wherein the tissue sample is        obtained from the CNS of the patient.    -   7. The method of any one of embodiments 4-6, wherein the R132        mutation is detected using next generation sequencing (NGS)        without the use of PCR.    -   8. The method of any one of embodiments 1-7, wherein the method        comprises administering 150 mg of Compound 1 to the patient in        the solid form obtained from the method of Example 5.    -   9. The method of any one of embodiments 1-8, wherein Compound 1        is administered to the patient once every 12 hours on        consecutive days throughout a course of treatment.    -   10. The method of any one of embodiments 1-9, wherein Compound 1        is administered to the patient throughout a course of treatment        of at least 6 months.    -   11. The method of any one of embodiments 2-9, wherein Compound 1        is administered to the patient throughout a course of treatment        of at least 6 consecutive treatment cycles.    -   12. A method of treating a glioma cancer having an IDH-1        mutation in an adult patient, the method comprising        administering to the patient in need thereof

-   a. a pharmaceutical composition comprising a total of 150 mg of a    pharmaceutically acceptable solid form of    5-{[(1S)-1-(6-chloro-2-oxo-1,2-dihydroquinolin-3-yl)ethyl]amino}-1-methyl-6-oxo-1,6-dihydropyridine-2-carbonitrile    obtained from Example 5, twice per day on consecutive days for a 28    day treatment cycle; and

-   b. administering azacitidine subcutaneously or intravenously to the    patient during the same treatment cycle as step (a), in a total dose    of 75 mg/m² each day for the first 7 consecutive days of the    treatment cycle followed by 21 consecutive days without the    administration of azacitidine until the end of the treatment cycle,    with the exception of optionally permitting a 48-hour dose    interruption of azacitidine on a weekend of holiday during the    treatment cycle.    -   13. A method of treating a glioma cancer having an IDH-1        mutation in an adult patient, the method comprising        administering to the patient in need thereof

-   a. a pharmaceutical composition comprising a total of 150 mg of a    Compound 1

in a pharmaceutically acceptable solid form (e.g. that obtainable fromExample 5), twice per day on consecutive days for a 28 day treatmentcycle; and

-   b. administering azacitidine subcutaneously or intravenously to the    patient during the same treatment cycle as step (a), in a total dose    of 75 mg/m² each day for the first 7 consecutive days of the    treatment cycle followed by 21 consecutive days without the    administration of azacitidine until the end of the treatment cycle,    with the exception of optionally permitting a 48-hour dose    interruption of azacitidine on a weekend of holiday during the    treatment cycle.    -   14. The method of any one of embodiments 1-13, wherein the        patient is diagnosed with glioblastoma multiforme prior to the        administration of Compound 1.    -   15. The method of any one of embodiments 1-14, wherein the        patient has elevated 2HG blood levels prior to the        administration of Compound 1.    -   16. The method of embodiment 15, wherein the level of 2HG        measured in the blood of the patient is greater than about 200        ng/mL prior to the administration of Compound 1.    -   17. The method of any one of embodiments 1-16, wherein the level        of 2HG measured in the blood of the patient is less than about        100 ng/mL measured on day 15 after the administration of        Compound 1 for the first 14 consecutive days of the first        treatment cycle.

The present disclosure also contemplates, among other things, thefollowing numbered embodiments:

-   -   1. A method of treating a patient diagnosed with a non-CNS solid        tumor harboring a cancer cell with an IDH1 R132 mutation, the        method comprising administering to the patient in need thereof a        therapeutically effective amount of Compound 1 as a single        agent.    -   2. A method of treating a patient diagnosed with glioma        harboring a cancer cell with an IDH1 R132 mutation, the method        comprising administering to the patient in need thereof a        therapeutically effective amount Compound 1 in combination with        a therapeutically effective amount of azacitidine.    -   3. A method of treating a patient diagnosed with a        chondrosarcoma cancer harboring a cancer cell with an IDH1 R132        mutation, the method comprising administering to the patient in        need thereof a therapeutically effective amount of Compound 1 in        combination with a therapeutically effective amount of        azacitidine.    -   4. A method of treating a patient diagnosed with a hepatobiliary        cancer harboring a cancer cell with an IDH1 R132 mutation, the        method comprising administering to the patient in need thereof a        therapeutically effective amount of Compound 1 in combination        with a therapeutically effective amount of a PD-1 inhibitor.    -   5. A method of treating a patient diagnosed with an intrahepatic        cholangiocarcinoma cancer harboring a cancer cell with an IDH1        R132 mutation, the method comprising administering to the        patient in need thereof a therapeutically effective amount of        Compound 1 in combination with a therapeutically effective        amount of a gemcitabine and cisplatin chemotherapy.    -   6. The method of any one of embodiments 1-5, wherein Compound 1        is administered at a dose of 150 mg taken orally twice daily.    -   7. The method of any one of embodiments 1-6, wherein Compound 1        is orally administered as the solid form obtained from Example        5.    -   8. The method of any one of embodiments 1-7, further comprising        the steps of:        -   a. selecting a patient diagnosed with the cancer harboring            an IDH1 mutation;        -   b. administering Compound 1 to the selected patient from            step (a) at a starting dose of 150 mg taken orally twice            daily for a treatment cycle of 28 consecutive days.    -   9. A method of treating a solid tumor or CNS cancer having an        IDH1 mutation in an adult patient, the method comprising        administering to the patient in need thereof a pharmaceutical        composition comprising a total of 150 mg of a pharmaceutically        acceptable solid form of        5-{[(1S)-1-(6-chloro-2-oxo-1,2-dihydroquinolin-3-yl)ethyl]amino}-1-methyl-6-oxo-1,6-dihydropyridine-2-carbonitrile        obtained from Example 5, twice per day on consecutive days for a        28 day treatment cycle.    -   10. The method of any one of embodiments 1-9, wherein the cancer        does not harbor a IDH2 mutation.    -   11. The method of any one of embodiments 1-10, wherein the        cancer does not harbor a IDH2 mutation selected from the group        consisting of: IDH2 R172K and IDH2 R140Q.    -   12. The method of any one of embodiments 1-11, comprising the        step of detecting the IDH1 mutation in a cell from the patient        using a next-generation sequencing (NGS)-based tumor genotyping        assay.    -   13. The method of any one of embodiments 1-12, wherein        administration of Compound 1 to the patient results in a        decreased 2-hydroxyglutarate (2-HG) levels in the blood of the        patient after the first 15 consecutive days of treatment of the        patient with Compound 1.    -   14. The method of any one of embodiments 1-13, wherein the        method comprises administering 150 mg of Compound 1 to the        patient in the solid form obtained from the method of Example 5.    -   15. The method of any one of embodiments 1-14, wherein the        method comprises administering 150 mg of Compound 1 to the        patient twice daily throughout a course of treatment.    -   16. The method of embodiment 15, wherein the course of treatment        is at least 15 consecutive days.    -   17. The method of any one of embodiments 1-16, wherein the        Compound 1 is administered to the patient once every 12 hours on        consecutive days throughout a course of treatment.    -   18. The method of any one of embodiments 1-17, wherein the        Compound 1 is administered to the patient throughout a course of        treatment of at least 4 months.    -   19. The method of any one of embodiments 1-17, wherein the        Compound 1 is administered to the patient throughout a course of        treatment of at least 6 months.    -   20. A method of treating a patient diagnosed with a cancer        selected from the group consisting of: glioma, chondrosarcoma,        hepatobiliary, and intrahepatic cholangiocarcinoma, the cancer        harboring an IDH1 R132 mutation, the method comprising        administering to the patient in need thereof a therapeutically        effective amount of a mIDH1 Inhibitor Therapy throughout a        Course of Treatment of at least one 28-day treatment cycle, the        mIDH1 Inhibitor Therapy consisting of        -   a. Compound 1 in combination with azacitidine for the            patient diagnosed with glioma or chondrosarcoma cancer; or        -   b. Compound 1 in combination with a PD-1 inhibitor for the            patient diagnosed with hepatobiliary cancer; or        -   c. Compound 1 in combination with gemcitabine and cisplatin            chemotherapy for the patient diagnosed with intrahepatic            cholangiocarcinoma.    -   21. The method of embodiment 20, wherein Compound 1 is        administered at a dose of 150 mg BID.    -   22. The method of any one of embodiments 20-21, wherein the PD-1        inhibitor is nivolumab.    -   23. The method of any one of embodiments 20-22, wherein the        nivolumab is administered at a dose of 240 mg every 2 weeks or        480 mg every 4 weeks.    -   24. The method of any one of embodiments 20-23, wherein the        azacitidine is administered at a dose of 75 mg/m², SC, d1-7, q4        wk throughout the Course of Treatment.    -   25. The method of any one of embodiments 20-24, wherein the        Course of Treatment is at least 4 months.    -   26. The method of any one of embodiments 20-25, wherein the        Course of Treatment is at least 6 months.    -   27. The method of any one of embodiments 1-26, wherein the        Compound 1 is administered as an oral dosage form obtained from        Example 5.

The present disclosure also contemplates, among other things, thefollowing numbered embodiments:

-   -   1. A method of treating a patient diagnosed with a        chondrosarcoma cancer harboring a cancer cell with an IDH1 R132        mutation, the method comprising administering to the patient in        need thereof a therapeutically effective amount of Compound 1 in        combination with a therapeutically effective amount of        azacitidine.    -   2. The method of embodiment 1, wherein Compound 1 is        administered at a dose of 150 mg taken orally twice daily.    -   3. The method of any one of embodiments 1-2, wherein Compound 1        is orally administered as the solid form obtained from Example        5.    -   4. The method of any one of embodiments 1-3, further comprising        the steps of:        -   a. selecting a patient diagnosed with the cancer harboring            an IDH1 mutation;        -   b. administering Compound 1 to the selected patient from            step (a) at a starting dose of 150 mg taken orally twice            daily for a treatment cycle of 28 consecutive days.    -   5. The method of any one of embodiments 1-4, wherein the cancer        does not harbor a IDH2 mutation.    -   6. The method of any one of embodiments 1-5, wherein the cancer        does not harbor a IDH2 mutation selected from the group        consisting of: IDH2 R172K and IDH2 R140Q.    -   7. The method of any one of embodiments 1-6, comprising the step        of detecting the IDH1 mutation in a cell from the patient using        a next-generation sequencing (NGS)-based tumor genotyping assay.    -   8. The method of any one of embodiments 1-7, wherein        administration of Compound 1 to the patient results in a        decreased 2-hydroxyglutarate (2-HG) levels in the blood of the        patient after the first 15 consecutive days of treatment of the        patient with Compound 1.    -   9. The method of any one of embodiments 1-8, wherein the method        comprises administering 150 mg of Compound 1 to the patient in        the solid form obtained from the method of Example 5.    -   10. The method of any one of embodiments 1-9, wherein the method        comprises administering 150 mg of Compound 1 to the patient        twice daily throughout a course of treatment.    -   11. The method of embodiment 10, wherein the course of treatment        is at least 15 consecutive days.    -   12. The method of any one of embodiments 1-11, wherein the        Compound 1 is administered to the patient once every 12 hours on        consecutive days throughout a course of treatment.    -   13. The method of any one of embodiments 1-12, wherein the        Compound 1 is administered to the patient throughout a course of        treatment of at least 4 months.    -   14. The method of any one of embodiments 1-12, wherein the        Compound 1 is administered to the patient throughout a course of        treatment of at least 6 months.    -   15. A method of treating a patient diagnosed with a cancer,        wherein the cancer is chondrosarcoma, the cancer harboring an        IDH1 R132 mutation, the method comprising administering to the        patient in need thereof a therapeutically effective amount of a        mIDH1 Inhibitor Therapy throughout a Course of Treatment of at        least one 28-day treatment cycle, the mIDH1 Inhibitor Therapy        consisting of Compound 1 in combination with azacitidine for the        patient diagnosed with glioma or chondrosarcoma cancer.    -   16. The method of embodiment 15, wherein Compound 1 is        administered at a dose of 150 mg BID.    -   17. The method of any one of embodiments 15-16, wherein the        azacitidine is administered at a dose of 75 mg/m², SC, d1-7, q4        wk throughout the Course of Treatment.    -   18. The method of any one of embodiments 15-17, wherein the        Course of Treatment is at least 4 months.    -   19. The method of any one of embodiments 15-18, wherein the        Course of Treatment is at least 6 months.    -   20. The method of any one of embodiments 1-19, wherein the        Compound 1 is administered as an oral dosage form obtained from        Example 5.

The present disclosure also contemplates, among other things, thefollowing numbered embodiments:

-   -   1. A method of treating a patient diagnosed with an intrahepatic        cholangiocarcinoma cancer harboring a cancer cell with an IDH1        R132 mutation, the method comprising administering to the        patient in need thereof a therapeutically effective amount of        Compound 1 in combination with a therapeutically effective        amount of a gemcitabine and cisplatin chemotherapy.    -   2. The method of embodiment 1, wherein Compound 1 is        administered at a dose of 150 mg taken orally twice daily.    -   3. The method of any one of embodiments 1-2, wherein Compound 1        is orally administered as the solid form obtained from Example        5.    -   4. The method of any one of embodiments 1-3, further comprising        the steps of:    -   a. selecting a patient diagnosed with the cancer harboring an        IDH1 mutation;    -   b. administering Compound 1 to the selected patient from        step (a) at a starting dose of 150 mg taken orally twice daily        for a treatment cycle of 28 consecutive days.    -   5. The method of any one of embodiments 1-4, wherein the cancer        does not harbor a IDH2 mutation.    -   6. The method of any one of embodiments 1-5, wherein the cancer        does not harbor a IDH2 mutation selected from the group        consisting of: IDH2 R172K and IDH2 R140Q.    -   7. The method of any one of embodiments 1-6, comprising the step        of detecting the IDH1 mutation in a cell from the patient using        a next-generation sequencing (NGS)-based tumor genotyping assay.    -   8. The method of any one of embodiments 1-7, wherein        administration of Compound 1 to the patient results in a        decreased 2-hydroxyglutarate (2-HG) levels in the blood of the        patient after the first 15 consecutive days of treatment of the        patient with Compound 1.    -   9. The method of any one of embodiments 1-8, wherein the method        comprises administering 150 mg of Compound 1 to the patient in        the solid form obtained from the method of Example 5.    -   10. The method of any one of embodiments 1-9, wherein the method        comprises administering 150 mg of Compound 1 to the patient        twice daily throughout a course of treatment.    -   11. The method of embodiment 10, wherein the course of treatment        is at least 15 consecutive days.    -   12. The method of any one of embodiments 1-11, wherein the        Compound 1 is administered to the patient once every 12 hours on        consecutive days throughout a course of treatment.    -   13. The method of any one of embodiments 1-12, wherein the        Compound 1 is administered to the patient throughout a course of        treatment of at least 4 months.    -   14. The method of any one of embodiments 1-12, wherein the        Compound 1 is administered to the patient throughout a course of        treatment of at least 6 months.    -   15. A method of treating a patient diagnosed with a cancer,        wherein the cancer is intrahepatic cholangiocarcinoma, the        cancer harboring an IDH1 R132 mutation, the method comprising        administering to the patient in need thereof a therapeutically        effective amount of a mIDH1 Inhibitor Therapy throughout a        Course of Treatment of at least one 28-day treatment cycle, the        mIDH1 Inhibitor Therapy consisting of Compound 1 in combination        with gemcitabine and cisplatin chemotherapy for the patient        diagnosed with intrahepatic cholangiocarcinoma.    -   16. The method of embodiment 15, wherein Compound 1 is        administered at a dose of 150 mg BID.    -   17. The method of any one of embodiments 15-16, wherein the        Course of Treatment is at least 4 months.    -   18. The method of any one of embodiments 15-17, wherein the        Course of Treatment is at least 6 months.    -   19. The method of any one of embodiments 1-18, wherein the        Compound 1 is administered as an oral dosage form obtained from        Example 5.

The present disclosure also contemplates, among other things, thefollowing numbered embodiments:

-   -   1. A method of treating a patient diagnosed with a hepatobiliary        cancer harboring a cancer cell with an IDH1 R132 mutation, the        method comprising administering to the patient in need thereof a        therapeutically effective amount of Compound 1 in combination        with a therapeutically effective amount of a PD-1 inhibitor.    -   2. The method of embodiment 1, wherein Compound 1 is        administered at a dose of 150 mg taken orally twice daily.    -   3. The method of any one of embodiments 1-2, wherein Compound 1        is orally administered as the solid form obtained from Example        5.    -   4. The method of any one of embodiments 1-3, further comprising        the steps of:        -   a. selecting a patient diagnosed with the cancer harboring            an IDH1 mutation;        -   b. administering Compound 1 to the selected patient from            step (a) at a starting dose of 150 mg taken orally twice            daily for a treatment cycle of 28 consecutive days.    -   5. The method of any one of embodiments 1-4, wherein the cancer        does not harbor a IDH2 mutation.    -   6. The method of any one of embodiments 1-5, wherein the cancer        does not harbor a IDH2 mutation selected from the group        consisting of: IDH2 R172K and IDH2 R140Q.    -   7. The method of any one of embodiments 1-6, comprising the step        of detecting the IDH1 mutation in a cell from the patient using        a next-generation sequencing (NGS)-based tumor genotyping assay.    -   8. The method of any one of embodiments 1-7, wherein        administration of Compound 1 to the patient results in a        decreased 2-hydroxyglutarate (2-HG) levels in the blood of the        patient after the first 15 consecutive days of treatment of the        patient with Compound 1.    -   9. The method of any one of embodiments 1-8, wherein the method        comprises administering 150 mg of Compound 1 to the patient in        the solid form obtained from the method of Example 5.    -   10. The method of any one of embodiments 1-9, wherein the method        comprises administering 150 mg of Compound 1 to the patient        twice daily throughout a course of treatment.    -   11. The method of embodiment 10, wherein the course of treatment        is at least 15 consecutive days.    -   12. The method of any one of embodiments 1-11, wherein the        Compound 1 is administered to the patient once every 12 hours on        consecutive days throughout a course of treatment.    -   13. The method of any one of embodiments 1-12, wherein the        Compound 1 is administered to the patient throughout a course of        treatment of at least 4 months.    -   14. The method of any one of embodiments 1-12, wherein the        Compound 1 is administered to the patient throughout a course of        treatment of at least 6 months.    -   15. A method of treating a patient diagnosed with a cancer,        wherein the cancer is hepatobiliary cancer, the cancer harboring        an IDH1 R132 mutation, the method comprising administering to        the patient in need thereof a therapeutically effective amount        of a mIDH1 Inhibitor Therapy throughout a Course of Treatment of        at least one 28-day treatment cycle, the mIDH1 Inhibitor Therapy        consisting of Compound 1 in combination with a PD-1 inhibitor        for the patient diagnosed with hepatobiliary cancer.    -   16. The method of embodiment 15, wherein Compound 1 is        administered at a dose of 150 mg BID.    -   17. The method of any one of embodiments 15-16, wherein the PD-1        inhibitor is nivolumab.    -   18. The method of any one of embodiments 15-17, wherein the        nivolumab is administered at a dose of 240 mg every 2 weeks or        480 mg every 4 weeks.    -   19. The method of any one of embodiments 15-18, wherein the        Course of Treatment is at least 4 months.    -   20. The method of any one of embodiments 15-19, wherein the        Course of Treatment is at least 6 months.    -   21. The method of any one of embodiments 1-20, wherein the        Compound 1 is administered as an oral dosage form obtained from        Example 5.

The present disclosure also contemplates, among other things, thefollowing numbered embodiments:

-   -   1. Use of a pharmaceutical composition comprising Compound 1, or        pharmaceutically acceptable salt thereof,

in treating a cancer harboring an isocitrate dehydrogenase-1 (IDH-1)mutation (mIDH-1) in a patient by administering a total of 300 mg ofCompound 1 (or a corresponding amount in the form of a pharmaceuticallyacceptable salt thereof) to a patient each day during a course oftreatment.

-   -   2. The use of embodiment 1, wherein a 150 mg amount of Compound        1 (or a corresponding amount in the form of a pharmaceutically        acceptable salt thereof) is administered to the patient twice        per day (BID) throughout the course of treatment.    -   3. The use of embodiment 1, wherein the cancer is a mIDH-1 form        of acute myeloid leukemia.    -   4. The use of embodiment 3, wherein the acute myeloid leukemia        is relapsed or refractory or is drug-resistant.    -   5. The use of embodiment 1, wherein the cancer is a mIDH-1 solid        tumor.    -   6. The use of embodiment 1, wherein the cancer is of a mIDH-1        glioma.    -   7. The use of embodiment 6, wherein the mIDH-1 glioma is an        advanced glioma that has recurred or progressed prior to the        administration of Compound 1.    -   8. The use of any one of the preceding embodiments, wherein the        mIDH1 is a R132X mutation.    -   9. The use of embodiment 8, wherein the R132X mIDH-1 mutation is        selected from R132L, R132G and R132S.    -   10. The use of any one of the preceding embodiments, wherein the        pharmaceutical composition comprising Compound 1 or a        pharmaceutically acceptable salt thereof is orally administered        to the patient.    -   11. The use of any one of the preceding embodiments, wherein        Compound 1, (or a corresponding amount in the form of a        pharmaceutically acceptable salt thereof) is administered as a        single agent for the treatment of the cancer harboring the IDH-1        mutation.    -   12. The use of any of the preceding embodiments, wherein the        course of treatment is at least 15 consecutive days to reach a        steady state blood concentration of Compound 1 (or a        corresponding amount in the form of a pharmaceutically        acceptable salt thereof) in the patient.    -   13. The use of any one of the preceding embodiments, wherein the        course of treatment is at least 6 months.    -   14. The use of any one of the preceding embodiments, wherein the        pharmaceutical composition comprises Compound 1 in a Type A        solid form characterized by a reflection X-ray powder        diffraction (XRPD) pattern comprising characteristic peaks at        6.3, 12.8, 13.8, 23.6, and 27.8 degrees±0.2° 2θ.    -   15. The use of any one of the preceding embodiments, wherein the        pharmaceutical composition comprises the following formulation        for oral administration: (a) Type A solid form of Compound 1 in        a relative weight of about 33, (b) a microcrystalline cellulose        in a relative weight of about 61, (c) a croscamellose sodium in        a relative weight of about 5 and a magnesium stearate in a        relative weight of about 1;        wherein the Type A solid form of Compound 1 is characterized by        a reflection X-ray powder diffraction (XRPD) pattern comprising        characteristic peaks at 6.3, 12.8, 13.8, 23.6, and 27.8        degrees±0.2° 2θ.

The present disclosure also contemplates, among other things, thefollowing numbered embodiments:

-   -   1. A pharmaceutical composition comprising Compound 1:

or pharmaceutically acceptable salt thereof, for use in treating apatient diagnosed with a form of cancer harboring an isocitratedehydrogenase-1 (IDH-1) mutation (mIDH-1) by administering a total of300 mg of Compound 1 (or a corresponding amount in the form of apharmaceutically acceptable salt thereof) to the patient each day duringa course of treatment.

-   -   2. The pharmaceutical composition of embodiment 1, wherein a 150        mg amount of Compound 1 (or a corresponding amount in the form        of a pharmaceutically acceptable salt thereof) is administered        to the patient twice per day (BID) throughout the course of        treatment.    -   3. The pharmaceutical composition of embodiment 1, wherein the        cancer is a mIDH-1 form of acute myeloid leukemia.    -   4. The pharmaceutical composition of embodiment 3, wherein the        acute myeloid leukemia is relapsed or refractory or is        drug-resistant.    -   5. The pharmaceutical composition of embodiment 1, wherein the        cancer is a mIDH-1 solid tumor.    -   6. The pharmaceutical composition of embodiment 1, wherein the        cancer is of a mIDH-1 glioma.    -   7. The pharmaceutical composition of embodiment 6, wherein the        mIDH-1 glioma is an advanced glioma that has recurred or        progressed prior to the administration of Compound 1.    -   8. The pharmaceutical composition of any one of the preceding        embodiments, wherein the mIDH1 is a R132X mutation.    -   9. The pharmaceutical composition of embodiment 8, wherein the        R132X mIDH-1 mutation is selected from R132L, R132G and R132S.    -   10. The pharmaceutical composition of any one of the preceding        embodiments, wherein the pharmaceutical composition comprising        Compound 1 or a pharmaceutically acceptable salt thereof is        orally administered to the patient.    -   11. The pharmaceutical composition of any one of the preceding        embodiments, wherein Compound 1, (or a corresponding amount in        the form of a pharmaceutically acceptable salt thereof) is        administered as a single agent for the treatment of the cancer        harboring the IDH-1 mutation.    -   12. The pharmaceutical composition of any of the preceding        embodiments, wherein the course of treatment is at least 15        consecutive days to reach a steady state blood concentration of        Compound 1 (or a corresponding amount in the form of a        pharmaceutically acceptable salt thereof) in the patient.    -   13. The pharmaceutical composition of any one of the preceding        embodiments, wherein the course of treatment is at least 6        months.    -   14. The pharmaceutical composition of any one of the preceding        embodiments, wherein the pharmaceutical composition comprises        Compound 1 in a Type A solid form characterized by a reflection        X-ray powder diffraction (XRPD) pattern comprising        characteristic peaks at 6.3, 12.8, 13.8, 23.6, and 27.8        degrees±0.2° 2θ.    -   15. The pharmaceutical composition of any one of the preceding        embodiments, wherein the pharmaceutical composition comprises        the following formulation for oral administration: (a) Type A        solid form of Compound 1 in a relative weight of about 33, (b) a        microcrystalline cellulose in a relative weight of about 61, (c)        a croscamellose sodium in a relative weight of about 5 and a        magnesium stearate in a relative weight of about 1; wherein the        Type A solid form of Compound 1 is characterized by a reflection        X-ray powder diffraction (XRPD) pattern comprising        characteristic peaks at 6.3, 12.8, 13.8, 23.6, and 27.8        degrees±0.2° 2θ.

The present disclosure also contemplates, among other things, thefollowing numbered embodiments:

-   -   1. A method of treating a patient diagnosed with a form of        cancer harboring a R132X IDH1 mutation, the method comprising        administering to the patient in need thereof a total of 150 mg        of the compound of Formula (1) twice per day (BID)

-   -   2. The method of embodiment 1 above, wherein the R132X IDH1        mutation is selected from the group consisting of: R132H and        R132C IDH1 mutations.    -   3. The method of embodiment 1 above, wherein the R132X IDH1        mutation is selected from the group consisting of: R132S, R132G,        and R132L IDH1 mutations.    -   4. The method of any one of the enumerated embodiments above,        wherein the compound of Formula (1) is orally administered to        the patient.    -   5. The method of any one of the enumerated embodiments above,        further comprising administering a total of 150 mg BID of the        compound of Formula (1) to the patient throughout a course of        treatment of at least 15 consecutive days.    -   6. The method of embodiment 5 above, further comprising        administering a total of 150 mg BID of the compound of        Formula (1) to the patient on consecutive days throughout a        course of treatment of between 15 days and 6 months.    -   7. The method of embodiment 5 above, further comprising        administering a total of 150 mg BID of the compound of        Formula (1) to the patient on consecutive days throughout a 6        month course of treatment.    -   8. The method of any one of the enumerated embodiments 1-7        above, wherein the compound of Formula (1) is administered to        the patient in an oral unit dosage form.    -   9. A method of treating a patient diagnosed with acute myeloid        leukemia (AML) having an IDH1 mutation, the method comprising        administering to the patient in need thereof a combination of        azacitidine and the compound of Formula (1),

wherein a total of 150 mg of the compound of Formula (1) is administeredto the patient twice per day (BID) each day, and the azacitidine isadministered to the patient at a total dose of 75 mg/m² each day for 7consecutive days beginning at the start of each treatment cycle,followed 21 consecutive days without administration of the azacitidineto the patient.

-   -   10. The method of embodiment 9 above, wherein the acute myeloid        leukemia is relapsed or refractory or is drug-resistant.    -   11. The method of any one of the embodiments 9-10 above, wherein        the IDH1 mutation is a R132X IDH1 mutation.    -   12. The method of any one of the embodiments 9-11 above, wherein        the R132X IDH1 mutation is selected from the group consisting        of: R132H and R132C IDH1 mutations.    -   13. The method of any one of the embodiments 9-11 above, wherein        the R132X IDH1 mutation is selected from the group consisting        of: R132S, R132G, and R132L IDH1 mutations.    -   14. The method of any one of the embodiments 9-13 above, further        comprising administering a total of 150 mg BID of the compound        of Formula (1) to the patient on consecutive days throughout a        course of treatment of between 15 days and 6 months.    -   15. The method of any one of the embodiments 9-13 above, further        comprising administering a total of 150 mg BID of the compound        of Formula (1) to the patient on consecutive days throughout a        course of treatment of at least 15 days.    -   16. The method of any one of the embodiments 9-13 above, further        comprising administering a total of 150 mg BID of the compound        of Formula (1) to the patient on consecutive days throughout a        course of treatment of at least 6 months.    -   17. A method of treating a patient diagnosed with        myelodysplastic syndrome (MDS) having an IDH1 mutation, the        method comprising administering to the patient in need thereof a        combination of azacitidine and the compound of Formula (1),

wherein a total of 150 mg of the compound of Formula (1) is administeredto the patient twice per day (BID) each day, and the azacitidine isadministered to the patient at a total dose of 75 mg/m² each day for 7consecutive days beginning at the start of each treatment cycle,followed 21 consecutive days without administration of the azacitidineto the patient.

-   -   18. The method of embodiment 17 above, wherein the IDH1 mutation        is a R132X IDH1 mutation.    -   19. The method of embodiment 18 above, wherein the R132X IDH1        mutation is selected from the group consisting of: R132H and        R132C IDH1 mutations.    -   20. The method of embodiment 18 above, wherein the R132X IDH1        mutation is selected from the group consisting of: R132S, R132G,        and R132L IDH1 mutations.    -   21. The method of any one of the embodiments 17-20 above,        further comprising administering a total of 150 mg BID of the        compound of Formula (1) to the patient on consecutive days        throughout a course of treatment of between 15 days and 6        months.    -   22. The method of any one of the embodiments 17-20 above,        further comprising administering a total of 150 mg BID of the        compound of Formula (1) to the patient on consecutive days        throughout a course of treatment of at least 15 days.    -   23. The method of any one of the embodiments 17-20 above,        further comprising administering a total of 150 mg BID of the        compound of Formula (1) to the patient on consecutive days        throughout a course of treatment of at least 6 months.    -   24. A method of treating a patient diagnosed with        myelodysplastic syndrome (MDS) having an IDH1 mutation, the        method comprising administering to the patient in need thereof        the compound of Formula (1),

wherein a total of 150 mg of the compound of Formula (1) is administeredto the patient twice per day (BID) each day.

-   -   25. The method of embodiment 24 above, wherein the acute myeloid        leukemia is relapsed or refractory or is drug-resistant.    -   26. The method of any one of the embodiments 24-25 above,        wherein the IDH1 mutation is a R132X IDH1 mutation.    -   27. The method of embodiment 26 above, wherein the R132X IDH1        mutation is selected from the group consisting of: R132H and        R132C IDH1 mutations.    -   28. The method of embodiment 26 above, wherein the R132X IDH1        mutation is selected from the group consisting of: R132S, R132G,        and R132L IDH1 mutations.    -   29. The method of any one of the embodiments 24-28 above,        further comprising administering a total of 150 mg BID of the        compound of Formula (1) to the patient on consecutive days        throughout a course of treatment of between 15 days and 6        months.    -   30. The method of any one of the embodiments 24-28 above,        further comprising administering a total of 150 mg BID of the        compound of Formula (1) to the patient on consecutive days        throughout a course of treatment of at least 15 days.    -   31. The method of any one of the embodiments 24-28 above,        further comprising administering a total of 150 mg BID of the        compound of Formula (1) to the patient on consecutive days        throughout a course of treatment of at least 6 months.    -   32. A method of treating a patient diagnosed with glioma having        an IDH1 mutation, wherein the method comprises administering to        the patient in need thereof the compound of Formula (1),

wherein a total of 150 mg of the compound of Formula (1) is administeredto the patient twice per day (BID) each day.

-   -   33. The method of any one of the embodiments above, wherein the        IDH1 mutation is a R132X IDH1 mutation.    -   34. The method of embodiment 33 above, wherein the R132X IDH1        mutation is selected from the group consisting of: R132H and        R132C IDH1 mutations.    -   35. The method of embodiment 34 above, wherein the R132X IDH1        mutation is selected from the group consisting of: R132S, R132G,        and R132L IDH1 mutations.    -   36. The method of any one of the embodiments 32-35 above,        further comprising administering a total of 150 mg BID of the        compound of Formula (1) to the patient on consecutive days        throughout a course of treatment of between 15 days and 6        months.    -   37. The method of any one of the embodiments 32-35 above,        further comprising administering a total of 150 mg BID of the        compound of Formula (1) to the patient on consecutive days        throughout a course of treatment of at least 15 days.    -   38. The method of any one of the embodiments 32-35 above,        further comprising administering a total of 150 mg BID of the        compound of Formula (1) to the patient on consecutive days        throughout a course of treatment of at least 6 months.    -   39. A method of treating a patient diagnosed with chondrosarcoma        having an IDH1 mutation, wherein the method comprises        administering to the patient in need thereof the compound of        Formula (1),

wherein a total of 150 mg of the compound of Formula (1) is administeredto the patient twice per day (BID) each day.

-   -   40. The method of any one of the embodiments above, wherein the        IDH1 mutation is a R132X IDH1 mutation.    -   41. The method of embodiment 40 above, wherein the R132X IDH1        mutation is selected from the group consisting of: R132H and        R132C IDH1 mutations.    -   42. The method of embodiment 40 above, wherein the R132X IDH1        mutation is selected from the group consisting of: R132S, R132G,        and R132L IDH1 mutations.    -   43. The method of any one of the embodiments 39-42 above,        further comprising administering a total of 150 mg BID of the        compound of Formula (1) to the patient on consecutive days        throughout a course of treatment of between 15 days and 6        months.    -   44. The method of any one of the embodiments 39-42 above,        further comprising administering a total of 150 mg BID of the        compound of Formula (1) to the patient on consecutive days        throughout a course of treatment of at least 15 days.    -   45. The method of any one of the embodiments 39-42 above,        further comprising administering a total of 150 mg BID of the        compound of Formula (1) to the patient on consecutive days        throughout a course of treatment of at least 6 months.    -   46. A method of treating a patient diagnosed with hepatobiliary        cholangiocarcinoma having an IDH1 mutation, wherein the method        comprises administering to the patient in need thereof the        compound of Formula (1),

wherein a total of 150 mg of the compound of Formula (1) is administeredto the patient twice per day (BID) each day.

-   -   47. The method of embodiment 46 above, wherein the IDH1 mutation        is a R132X IDH1 mutation.    -   48. The method of embodiment 47 above, wherein the R132X IDH1        mutation is selected from the group consisting of: R132H and        R132C IDH1 mutations.    -   49. The method of embodiment 47 above, wherein the R132X IDH1        mutation is selected from the group consisting of: R132S, R132G,        and R132L IDH1 mutations.    -   50. The method of any one of the embodiments 46-49 above,        further comprising administering a total of 150 mg BID of the        compound of Formula (1) to the patient on consecutive days        throughout a course of treatment of between 15 days and 6        months.    -   51. The method of any one of the embodiments 46-49 above,        further comprising administering a total of 150 mg BID of the        compound of Formula (1) to the patient on consecutive days        throughout a course of treatment of at least 15 days.    -   52. The method of any one of the embodiments 46-49 above,        further comprising administering a total of 150 mg BID of the        compound of Formula (1) to the patient on consecutive days        throughout a course of treatment of at least 6 months.    -   53. A method of treating a patient diagnosed with intrahepatic        cholangiocarcinoma having an IDH1 mutation, wherein the method        comprises administering to the patient in need thereof the        compound of Formula (1),

wherein a total of 150 mg of the compound of Formula (1) is administeredto the patient twice per day (BID) each day.

-   -   54. The method of embodiment 53 above, wherein the IDH1 mutation        is a R132X IDH1 mutation.    -   55. The method of embodiment 54 above, wherein the R132X IDH1        mutation is selected from the group consisting of: R132H and        R132C IDH1 mutations.    -   56. The method of embodiment 54 above, wherein the R132X IDH1        mutation is selected from the group consisting of: R132S, R132G,        and R132L IDH1 mutations.    -   57. The method of any one of the embodiments 53-56 above,        further comprising administering a total of 150 mg BID of the        compound of Formula (1) to the patient on consecutive days        throughout a course of treatment of between 15 days and 6        months.    -   58. The method of any one of the embodiments 53-56 above,        further comprising administering a total of 150 mg BID of the        compound of Formula (1) to the patient on consecutive days        throughout a course of treatment of at least 15 days.    -   59. The method of any one of the embodiments 53-56 above,        further comprising administering a total of 150 mg BID of the        compound of Formula (1) to the patient on consecutive days        throughout a course of treatment of at least 6 months.    -   60. A method of treating a patient diagnosed with glioma having        an IDH1 mutation, wherein the method comprises administering to        the patient in need thereof a combination of azacitidine and the        compound of Formula (1),

wherein a total of 150 mg of the compound of Formula (1) is administeredto the patient twice per day (BID) each day, and the azacitidine isadministered to the patient at a total dose of 75 mg/m² each day for 7consecutive days beginning at the start of each treatment cycle,followed 21 consecutive days without administration of the azacitidineto the patient.

-   -   61. The method of embodiment 60 above, wherein the IDH1 mutation        is a R132X IDH1 mutation.    -   62. The method of embodiment 61 above, wherein the R132X IDH1        mutation is selected from the group consisting of: R132H and        R132C IDH1 mutations.    -   63. The method of embodiment 61 above, wherein the R132X IDH1        mutation is selected from the group consisting of: R132S, R132G,        and R132L IDH1 mutations.    -   64. The method of any one of the embodiments 60-63 above,        further comprising administering a total of 150 mg BID of the        compound of Formula (1) to the patient on consecutive days        throughout a course of treatment of between 15 days and 6        months.    -   65. The method of any one of the embodiments 60-63 above,        further comprising administering a total of 150 mg BID of the        compound of Formula (1) to the patient on consecutive days        throughout a course of treatment of at least 15 days.    -   66. The method of any one of the embodiments 60-63 above,        further comprising administering a total of 150 mg BID of the        compound of Formula (1) to the patient on consecutive days        throughout a course of treatment of at least 6 months.    -   67. A method of treating a patient diagnosed with chondrosarcoma        having an IDH1 mutation, wherein the method comprises        administering to the patient in need thereof a combination of        azacitidine and the compound of Formula (1),

wherein a total of 150 mg of the compound of Formula (1) is administeredto the patient twice per day (BID) each day, and the azacitidine isadministered to the patient at a total dose of 75 mg/m² each day for 7consecutive days beginning at the start of each treatment cycle,followed 21 consecutive days without administration of the azacitidineto the patient.

-   -   68. The method of embodiment 67 above, wherein the IDH1 mutation        is a R132X IDH1 mutation.    -   69. The method of embodiment 68 above, wherein the R132X IDH1        mutation is selected from the group consisting of: R132H and        R132C IDH1 mutations.    -   70. The method of embodiment 68 above, wherein the R132X IDH1        mutation is selected from the group consisting of: R132S, R132G,        and R132L IDH1 mutations.    -   71. The method of any one of the embodiments 67-70 above,        further comprising administering a total of 150 mg BID of the        compound of Formula (1) to the patient on consecutive days        throughout a course of treatment of between 15 days and 6        months.    -   72. The method of any one of the embodiments 67-70 above,        further comprising administering a total of 150 mg BID of the        compound of Formula (1) to the patient on consecutive days        throughout a course of treatment of at least 15 days.    -   73. The method of any one of the embodiments 67-70 above,        further comprising administering a total of 150 mg BID of the        compound of Formula (1) to the patient on consecutive days        throughout a course of treatment of at least 6 months.    -   74. A method of treating a patient diagnosed with hepatobiliary        cholangiocarcinoma having an IDH1 mutation, wherein the method        comprises administering to the patient in need thereof a        combination of azacitidine and the compound of Formula (1),

wherein a total of 150 mg of the compound of Formula (1) is administeredto the patient twice per day (BID) each day, and the azacitidine isadministered to the patient at a total dose of 75 mg/m² each day for 7consecutive days beginning at the start of each treatment cycle,followed 21 consecutive days without administration of the azacitidineto the patient.

-   -   75. The method of embodiment 74 above, wherein the IDH1 mutation        is a R132X IDH1 mutation.    -   76. The method of embodiment 75 above, wherein the R132X IDH1        mutation is selected from the group consisting of: R132H and        R132C IDH1 mutations.    -   77. The method of embodiment 75 above, wherein the R132X IDH1        mutation is selected from the group consisting of: R132S, R132G,        and R132L IDH1 mutations.    -   78. The method of any one of the embodiments 74-77 above,        further comprising administering a total of 150 mg BID of the        compound of Formula (1) to the patient on consecutive days        throughout a course of treatment of between 15 days and 6        months.    -   79. The method of any one of the embodiments 74-77 above,        further comprising administering a total of 150 mg BID of the        compound of Formula (1) to the patient on consecutive days        throughout a course of treatment of at least 15 days.    -   80. The method of any one of the embodiments 74-77 above,        further comprising administering a total of 150 mg BID of the        compound of Formula (1) to the patient on consecutive days        throughout a course of treatment of at least 6 months.    -   81. A method of treating a patient diagnosed with intrahepatic        cholangiocarcinoma having an IDH1 mutation, wherein the method        comprises administering to the patient in need thereof a        combination of azacitidine and the compound of Formula (1),

wherein a total of 150 mg of the compound of Formula (1) is administeredto the patient twice per day (BID) each day, and the azacitidine isadministered to the patient at a total dose of 75 mg/m² each day for 7consecutive days beginning at the start of each treatment cycle,followed 21 consecutive days without administration of the azacitidineto the patient.

-   -   82. The method of embodiment 81 above, wherein the IDH1 mutation        is a R132X IDH1 mutation.    -   83. The method of embodiment 82 above, wherein the R132X IDH1        mutation is selected from the group consisting of: R132H and        R132C IDH1 mutations.    -   84. The method of embodiment 82 above, wherein the R132X IDH1        mutation is selected from the group consisting of: R132S, R132G,        and R132L IDH1 mutations.    -   85. The method of any one of the embodiments 81-84 above,        further comprising administering a total of 150 mg BID of the        compound of Formula (1) to the patient on consecutive days        throughout a course of treatment of between 15 days and 6        months.    -   86. The method of any one of the embodiments 81-84 above,        further comprising administering a total of 150 mg BID of the        compound of Formula (1) to the patient on consecutive days        throughout a course of treatment of at least 15 days.    -   87. The method of any one of the embodiments 81-84 above,        further comprising administering a total of 150 mg BID of the        compound of Formula (1) to the patient on consecutive days        throughout a course of treatment of at least 6 months.    -   88. The method of any one of the embodiments 1-87 above, wherein        the compound of Formula (1) is administered in a crystalline        form.    -   89. The method of any one of the embodiments 1-88 above, wherein        the compound of Formula (1) is administered as a Type A        crystalline form.    -   90. The method of any one of the embodiments 1-89 above, wherein        the compound of Formula (1) is orally administered in a capsule        comprising a total of 150 mg of the compound of Formula (1).    -   91. The method of any one of the embodiments 1-90 above, wherein        the compound of Formula (1) is orally administered in multiple        capsules each comprising a total of 50 mg of the compound of        Formula (1).

The present disclosure also contemplates, among other things, thefollowing numbered embodiments:

1. A method of treating acute myeloid leukemia (AML) in patients with anisocitrate dehydrogenase-1 (IDH1) mutation, the method comprising stepsof:

-   -   a. isolating and purifying DNA from a sample obtained from a        patient;    -   b. detecting an IDH1 mutation in the DNA from the sample; and    -   c. administering to the patient with the IDH1 mutation a total        of 150 mg of olutasidenib twice daily in a pharmaceutically        acceptable composition.        2. The method of embodiment 1, wherein the IDH1 mutation is an        IDH1 R132 mutation.        3. The method of embodiment 2, wherein the IDH1 R132 mutation is        selected from the group consisting of R132C, R132H, R132S,        R132G, and R132L.        4. The method of embodiment 1, wherein the detecting an IDH1        mutation comprises detecting a single nucleotide variant (SNV)        coding the IDH1 mutation, wherein the IDH1 mutation is selected        from the group consisting of R132C, R132H, R132G, R132S, and        R132L.        5. The method of embodiment 4, wherein the IDH1 mutation is        detected using polymerase chain reaction (PCR) technology with        homogeneous real-time fluorescence detection.        6. The method of embodiment 1, wherein the detecting an IDH1        mutation comprises using an in vitro PCR assay for the        qualitative detection of single nucleotide variants (SNVs)        coding an IDH1 R132 mutation selected from the group consisting        of R132C, R132H, R132G, R132S, and R132L in the DNA from the        sample.        7. The method of embodiment 1, wherein the sample is obtained        from patient bone marrow.        8. The method of embodiment 1, wherein the sample is obtained        from patient blood.        9. The method of embodiment 1, wherein the pharmaceutically        acceptable composition is formulated for oral administration.        10. The method of embodiment 9, wherein the pharmaceutically        acceptable composition is a capsule.        11. The method of embodiment 5, wherein the method further        comprises combining the extracted DNA sample with        oligonucleotide primers designed to specifically amplify (i)        R132C and R132H mutations or (ii) R132G, R132S, and R132L        mutations.        12. The method of embodiment 11, wherein the real-time        fluorescence signal of each IDH1 mutation of either (i) R132C        and R132H or (ii) R132G, R132S, and R132L is distinguishable in        a single well.        13. A method of treating acute myeloid leukemia (AML) in        patients with an isocitrate dehydrogenase-1 (IDH1) mutation, the        method comprising administering twice daily to a patient with an        IDH1 mutation 150 mg of olutasidenib in a pharmaceutically        acceptable composition, wherein the IDH1 mutation has been        detected using an FDA-approved diagnostic test.        14. The method of embodiment 13, wherein the FDA-approved        diagnostic test is the IDH1 Assay of Example 14.    -   15. The method of embodiment 13, wherein the patient is        receiving or has received therapy comprising azacitidine or        cytarabine.        16. The method of embodiment 13, wherein the AML is relapsed or        refractory.        17. A method of treating AML in patients with an isocitrate        dehydrogenase-1 (IDH1) mutation, the method comprising steps of:        determining whether the patient has an IDH1 mutation by:    -   i. obtaining a sample from the patient; and    -   ii. performing an assay on the sample to determine if the        patient has an IDH1 mutation; and if the patient has an IDH1        mutation, then administering to the patient with the IDH1        mutation a total of 150 mg of olutasidenib twice daily in a        pharmaceutically acceptable composition, and        -   if the patient does not have an IDH1 mutation, then not            administering to the patient with the IDH1 mutation a total            of 150 mg of olutasidenib twice daily in a pharmaceutically            acceptable composition.            18. The method of embodiment 17, wherein the IDH1 mutation            is an IDH1 R132 mutation.            19. The method of embodiment 18, wherein the IDH1 R132            mutation is selected from the group consisting of R132C,            R132H, R132S, R132G, and R132L.            20. The method of embodiment 17, wherein the assay is the            IDH1 Assay of Example 14.

The present disclosure also contemplates, among other things, thefollowing numbered embodiments:

1. A method of treating a patient diagnosed with a cancer characterizedby (i) an IDH-1 mutation selected from R132G, R132S, and R132L and (ii)a mutation selected from DNMT3A, NPM1, SRSF2, NRAS, RUNX1, ASXL1, FLT3,STAG2, TET2, SMC1A, SF3B1, U2AF1, PHF6, JAK2, MPL, NF1, ASXL2, BCOR,EED, WT1, CBL, CSF3R, ETNK1, PTPN11, ATM and TP53, the method comprisingorally administering 150 mg of Compound 1:

twice daily to the patient in need thereof.2. The method of embodiment 1, wherein the cancer is not characterizedby an IDH2 mutation.3. The method of embodiment 1 or 2, wherein the cancer is characterizedby a mutation selected from FLT3, NPM1, CEBPA and TP53.

-   -   4. The method of any one of embodiments 1-3, wherein the cancer        is characterized by a mutation selected from DNMT3A, TP53, ATM,        and NRAS.        5. The method of any one of embodiments 1-4, wherein the cancer        is acute myeloid leukemia or myelodysplastic syndrome.        6. The method of any one of embodiments 1-4, wherein the cancer        is glioma.        7. The method of any one of embodiments 1-6, wherein Compound 1        is administered to the patient every day for at least 6 months.        8. The method of any one of embodiments 1-7, wherein Compound 1        is administered as a single agent.        9. The method of any one of embodiments 1-7, wherein Compound 1        is administered to the patient in combination with azacitidine        during one or more 28-day treatment cycles, wherein:    -   a. the azacitidine is administered to the patient at the dose of        75 mg/m² for 7 days IV/SC per every 28-day cycle; and    -   b. a total of 150 mg of Compound 1 is administered BID to the        patient every day throughout the one or more 28-day treatment        cycles.        10. A method of treating a patient diagnosed with a        hematological malignancy characterized by (i) at least one IDH1        mutation selected from R132C, R132H, R132G, R132S, and R132L        and (ii) at least one mutation selected from CEBPA, DNMT3A,        NPM1, SRSF2, NRAS, RUNX1, ASXL1, FLT3, STAG2, TET2, SMC1A,        SF3B1, U2AF1, PHF6, JAK2, MPL, NF1, ASXL2, BCOR, EED, WT1, CBL,        CSF3R, ETNK1, PTPN11, ATM and TP53, the method comprising orally        administering 150 mg of Compound 1:

as a single agent twice daily to the patient in need thereof.11. The method of embodiment 10, wherein the hematological malignancy iswith acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS).12. A method of treating a patient diagnosed with glioma characterizedby (i) at least one IDH1 mutation selected from R132C, R132H, R132G,R132S, and R132L and (ii) at least one mutation selected from DNMT3A,TP53, ATM, and NRAS, the method comprising orally administering 150 mgof Compound 1:

twice daily to the patient in need thereof.13. The method of embodiment 12, wherein Compound 1 is administered as asingle agent for treatment of glioma.14. A method of treating a patient diagnosed with a hematologicalmalignancy characterized by (i) at least one IDH1 mutation selected fromR132C, R132H, R132G, R132S, and R132L and (ii) at least one mutationselected from CEBPA, DNMT3A, NPM1, SRSF2, NRAS, RUNX1, ASXL1, STAG2,TET2, SMC1A, SF3B1, U2AF1, PHF6, JAK2, MPL, NF1, ASXL2, BCOR, EED, WT1,CBL, CSF3R, ETNK1, PTPN11, ATM and TP53, the method comprising orallyadministering 150 mg of Compound 1:

twice daily in combination with azacitidine to the patient in needthereof.15. The method of embodiment 14, wherein the hematological malignancy ischaracterized by at least one mutation selected from NPM1, SRSF2, RUNX1,ASXL1, STAG2, TET2, SMC1A, SF3B1, U2AF1, PHF6, JAK2, MPL, NF1, ASXL2,EED, WT1, CBL, CSF3R, ETNK1, PTPN11, ATM and TP53.16. A method of treating a patient diagnosed with a glioma characterizedby an IDH1 mutation and at least one co-mutation selected from DNMT3A,TP53, ATM, and NRAS, the method comprising orally administering 150 mgof olutasidenib twice daily to the patient in need thereof.17. The method of embodiment 16, comprising repeatedly administering theolutasidenib to the patient in need thereof on consecutive daysthroughout a course of treatment of at least 15 consecutive days.18. The method of embodiment 17, wherein the course of treatment is oneor more consecutive 28-day treatment cycles.19. The method of embodiment 18, wherein the course of treatment is atleast 6 consecutive treatment cycles.20. The method of embodiment 19, wherein the course of treatment is atleast 9 consecutive treatment cycles.

The present disclosure also contemplates, among other things, thefollowing numbered embodiments:

1. A method of treating a patient diagnosed with a solid tumorcharacterized by an IDH1 mutation, the method comprising orallyadministering to the patient in need thereof a pharmaceuticalcomposition comprising a total of 150 mg of olutasidenib twice per day(BID).2. The method of embodiment 1, wherein the olutasidenib is administeredas a single agent.3. The method of embodiment 1 or 2, wherein the solid tumor is selectedfrom glioma, hepatobiliary carcinoma, chondrosarcoma, and intrahepaticcholangiocarcinoma.4. The method of any one of embodiments 1-3, wherein the olutasidenib isadministered to the patient in need thereof in a tablet or capsule oralunit dosage form on consecutive days throughout a course of treatment.5. The method of embodiment 4, wherein the course of treatment is atleast 15 consecutive days.6. The method of embodiment 4, wherein the course of treatment is atleast 6 months.7. The method of any one of embodiments 1-6, wherein the solid tumor ischaracterized by an R132 IDH1 mutation.8. A method of treating a patient diagnosed with a glioma characterizedby an IDH1 mutation, the method comprising orally administering to thepatient in need thereof a pharmaceutical composition comprising a totalof 150 mg of olutasidenib twice per day (BID).9. The method of embodiment 8, wherein the olutasidenib is administeredas a single agent.10. The method of embodiment 8 or 9, wherein the glioma is characterizedby an R132 IDH1 mutation.11. The method of embodiment 10, wherein the R132 IDH1 mutation isselected from R132C, R132H, R132G, R132S, and R132L.12. The method of embodiment 10 or 11, wherein the glioma is furthercharacterized by at least one mutation selected from TP53, GFAP, TERT,MGMT, 1p19q, OLIG2, ATRX, PI3K3CA, CDKN2B, CDKN2A, PTEN, NogoA, andDNMT3A.13. The method of any one of embodiments 10-12, wherein the glioma isfurther characterized by at least one mutation selected from DNMT3A,TP53, ATM, and NRAS.14. The method of any one of embodiments 8-13, wherein the glioma isrelapsed/refractory mIDH1 glioma.15. The method of any one of embodiments 8-14, wherein the patient haspreviously received temozoloide to treat a mIDH1 glioma prior toadministration of the olutasidenib to the patient.16. The method of any one of embodiments 8-15, wherein the olutasidenibis administered to the patient in need thereof in a tablet or capsuleoral unit dosage form on consecutive days throughout a course oftreatment of at least 15 consecutive days.17. A method of treating a patient diagnosed with a cancer characterizedby (i) an R132 IDH1 mutation and (ii) a concurrent mutation, the methodcomprising orally administering to the patient in need thereof apharmaceutical composition comprising a total of 150 mg of olutasidenibtwice per day (BID).18. The method of embodiment 17, wherein the concurrent mutation isselected from CEBPA, DNMT3A, NPM1, SRSF2, NRAS, RUNX1, ASXL1, FLT3,STAG2, IDH2, TET2, SMC1A, SF3B1, U2AF1, PHF6, JAK2, MPL, NF1, ASXL2,BCOR, EED, WT1, CBL, CSF3R, ETNK1, PTPN11, ATM, TP53, EZH2, SETBP1,GATA2, CBP, CUX1, GFAP, TERT, MGMT, 1p19q, OLIG2, ATRX, PI3K3CA, CDKN2B,CDKN2A, PTEN, and NogoA.19. The method of embodiment 17 or 18, wherein the R132 IDH mutation isselected from R132G, R132S, and R132L.20. The method of any one of embodiments 17-19, wherein the olutasidenibis administered to the patient in need thereof in a tablet or capsuleoral unit dosage form on consecutive days throughout a course oftreatment of at least 15 consecutive days.

EXAMPLES Example 1: Compound 1 Potently and Selectively Inhibited 2-HGProduction in IDH-1 R132H and IDH-1 R132C Mutant Enzymes in BiochemicalAssays, Compared to Wild Type IDH-1 Enzyme and Mutant IDH-2 Enzymes

The biochemical potencies of Compound 1 against IDH-1 R132H and IDH-1R132C mutants were determined in diaphorase-coupled assays, whichmeasure activity by the determination of the level of remainingco-substrate NADPH after the enzymatic reaction is quenched (FIG. 2A andFIG. 2B). FIG. 2A and FIG. 2B are schematics illustrating the workingprinciple of the diaphorase-coupled assay for measuring potency andselectivity of Compound 1 for IDH-1 and IDH-2 enzymes. Recombinanthomodimeric IDH-1 R132H or IDH-1 R132C mutant enzymes were used in theseassays.

Results are shown in Table 6, relative to the IC₅₀ value obtained forR132H IDH-1 mutated enzyme. Referring to data in Table 6, Compound 1 wasfound to selectively inhibit the enzymatic activity of the IDH-1 R132Hand IDH-1 R132C mutations with an IC₅₀ value within a factor of about 5(i.e., the IC₅₀ value measured for IDH-1 R132C mutant enzyme was about 5times higher than the IC₅₀ measured in the IDH-1 R132H mutated enzyme).The selectivity of Compound 1 against other IDH isozymes was also testedutilizing diaphorase coupled assays employing either wild-type IDH-1 orone of 2 alternate mutated forms of IDH-2, namely IDH-2 R172K and IDH-2R140.

TABLE 6 Target Relative Enzymatic IC₅₀ (Average +/− SEM) IDH-1 R132H 1.0(±6.6%) IDH-1 R132C 5.1 (±6.1%) Wild Type IDH-1 922 IDH-2 R172K >1,000IDH-2 R140Q >4,000 (no activity measured)

Compound 1 had comparatively very weak activity against wild type IDH-1(IC₅₀ value of about 922 times greater than the IC₅₀ value measured forIDH-1 R132H). Compound 1 also demonstrated very weak activity againstIDH-2 R172K that was more than 1,000 greater than the IC₅₀ valuemeasured for IDH-1 R132H. Compound 1 did not show any inhibition ofIDH-2 R140Q up to a concentration of 100 μM. These selectivity dataindicate that Compound 1 is a potent and selective inhibitor of IDH-1R132 mutations.

Example 2: Compound 1 Exhibited Specific Binding to a Surface ContainingImmobilized IDH-1 R132 Mutant Protein (Compared to a Comparator Surfacewith Immobilized BCL6), with Two Binding Sites Having Different KdValues Detected by Surface Plasmon Resonance Analysis

The biophysical interaction between Compound 1 and IDH-1 R132H wasfurther characterized using Surface Plasmon Resonance (SPR) technology.Compound 1 was shown to exhibit specific binding to the surfacecontaining immobilized IDH-1 R132H mutant protein compared to a controlsurface on which the unrelated protein BCL6 was immobilized, where nobinding was observed (FIG. 3A and FIG. 3B, respectively). Analysis ofthe SPR data revealed two binding sites between Compound 1 and IDH-1R132H, with Kd values of 31 nM (with kon1=2.04±0.03×105 M−1s−1 andkoff1=0.0063±0.0001 s−1) and 1200 nM (with kon2=1.56±0.03×105 M−1s−1 andkoff1=0.187±0.001 s−1), respectively. It is likely that the apparent lowaffinity binding site is an artifact of the immobilization of theprotein on the surface of the chip, and as the Kd value for the highaffinity binding site is close to the enzymatic IC₅₀ of Compound 1 forIDH-1 R132H, this was used to confirm specific binding of Compound 1 toIDH-1 R132H.

Example 3: Compound 1 Potently Inhibited 2-HG Production in IDH-1 R132G,IDH-1 R132L, and IDH-1 R132S Mutant Cell Lines in Cell Based Assays,with IC₅₀ Values Greater than IDH-1 R132C Mutant Cell Lines

The cellular potency of Compound 1 in suppressing intracellular 2-HGlevels was determined in cell lines expressing five different mutatedIDH-1 proteins found in human cancers (R132H, R132C, R132G, R132L,R132S). The human fibrosarcoma cell line HT-1080 harbors a naturallyoccurring heterozygous IDH-1 R132C mutation. The human colorectalcarcinoma cell line HCT 116 is wild type for IDH-1, but heterozygousmutations coding for IDH-1 R132H or R132C were introduced by knock-ininto the endogenous IDH-1 gene locus. Finally, the human astrocytomacell line U-87 MG is also wild type for IDH-1, but expression of fivedifferent mutated IDH-1 proteins was achieved by stable transfection.

The parental HCT 116 line (colon) line does not produce high levels of2-HG, but the variants used herein (X-MAN HCT-116 lines obtained fromHorizon Discovery Ltd.) are engineered to knock-in a heterozygousmutation of either IDH-1 R132H or IDH-1 R132C. This recapitulates thecellular context in mIDH-1 cancer cells where there are both wild typeand mutant IDH-1 subunits that together form a heterodimer that isresponsible for the production of elevated levels of 2-HG. Thesemodified lines can be used as models of IDH-1 mutant disease.

Each of these cell lines was treated with Compound 1 for 24 hr, andintracellular 2-HG levels were determined by mass spectroscopy. As shownin the Table 7, Compound 1 suppressed 2-HG production in each cell line,with IC₅₀ values ranging from less than 10 nM to less than 150 nM.Compound 1 is therefore a potent inhibitor of a variety of clinicallyrelevant IDH-1 mutations in a cellular context. Table 7 shows the IC₅₀values measured relative to the IC₅₀ value obtained for U-87 MG/IDH-1R132G.

TABLE 7 Cell Line Relative 2-HG IC₅₀* U-87MG/IDH-1 R132G  1.0 (±30%)U-87MG/IDH-1 R132S 1.17 (±21%) U-87MG/IDH-1 R132H 1.29 (±17%)U-87MG/IDH-1 R132L 5.39 (±22%) U-87MG/IDH-1 R132C 7.00 (±30%) HCT116(IDH-1 R132H/+) 3.36 (±19%) HT-1080(IDH-1 R132C/+) 9.66 (18%)  HCT116(IDH-1 R132C/+) 13.96 (±18%)  *Mean +/− SEM where applicable

Example 4: Testing Compound 1 in Mouse Xenograft Models Using HCT 116Cells with R132 C and R132H Mutations

In order to assess the in vivo activity of Compound 1, PK-PD experimentsin mice bearing HCT-116 xenografts (derived from Horizon Discoveryisogenic cell lines harboring IDH1-R132H and IDH1-R132C knock-inmutations) were used to determine the degree of exposure required tosuppress 2-HG levels. Compound 1 was administered to HCT116-IDH1-R132H/+xenograft bearing female BALB/c Nude mice at three oral doses (12.5, 25,and 50 mg/kg) in 12-hour intervals. Plasma and xenograft tumor sampleswere collected at 4, 12, and 24 hours post last dose to determine theexposure of Compound 1 in plasma and tumor, as well as to measure theinhibition of IDH1 mutant activity in tumor based on the reduction inlevels of 2-HG. In IDH1-R132H/+ xenograft models, the free concentrationof Compound 1 was comparable in plasma and xenograft tumors, andexposures were dose-dependent (FIG. 4A and FIG. 4B). In comparison tothe vehicle treated group, Compound 1 showed a time and dose-dependentinhibition of 2-HG levels in plasma and in tumor (FIG. 4C). At thehighest dose tested in these studies (50 mg/kg), treatment with Compound1 inhibited 2-HG levels in the tumor by >90% for up to 24 hours afterthe last dose in the HCT116-IDH1-R132H/+ xenograft model, and to similarlevels for at least 12 hours in the HCT116-IDH1-R132C/+ model.Calculations based upon the percentage of suppression of 2-HGconcentration in tumor versus the free drug concentration in tumor gavein vivo IC50 values of 26 nM and 36 nM in the HCT116-IDH1-R132H orHCT116-IDH1-R132C models, respectively. When corrected for unboundlevels of Compound 1, there is an excellent correlation in potency amongthe biochemical assay, cellular assay, and in vivo studies.

TABLE 8 mIDH1-R132H mIDH1-R132C Enzyme Cell 2- In vivo 2- Enzyme Cell 2-In vivo 2- (nM) HG (nM) HG (nM) (nM) HG (nM) HG (nM) 17 37 26 100 66 36

In order to optimize the dosing schedule of Compound 1 to achievesustained >90% 2-HG inhibition in mIDH-1 in vivo, HCT116 (IDH-1 R132H)and HCT116 (IDH-1 R132C) xenograft-bearing mice were treated withCompound 1 at 25 and 50 mg/kg BID (3 doses). The free drug concentrationof Compound 1 at 12 hour post final dose is above the in vivo IC90 forall doses, and a greater than 90% reduction of 2-HG levels in tumor wereachieved in each case. The free drug concentration decreased to 3-10×the in vivo IC50 at 24 hour post final dose, and Compound 1 showed80-90% inhibition. There was less than 20 nM free drug concentration intumor at 48 and 72 hours after final dose, and at that point there wasless than 50% 2-HG inhibition in tumor samples, consistent with thereduced level of Compound 1.

Briefly, 5×106 HCT-116 IDH1-R132H/+ cells (Horizon Discovery) in PBS wasinoculated subcutaneously at the right flank of the 6 weeks old femaleBALB/c nude mice. When the tumor size reached 360-400 mm3, mice wererandomized by tumor volume into nine mice per group. The tumor bearingmice were treated with vehicle (9:1 PEG400:Ethanol) or Compound 1 forthree doses with 12 hr dosing interval. The dosing volume was 10 L/g.The plasma samples and tumor samples were collected at 4, 12 and 24 hrpost final dose (N=3 mice per time point) for the subsequent measurementof compound level in plasma and tumor samples and of 2-HG level in thetumor samples by UPLC-MS-MS system.

In a separate dosing example, 5×106 HCT-116 IDH1-R132C/+ cells (HorizonDiscovery) in PBS was inoculated subcutaneously at the right flank ofthe 6-8 weeks old female BALB/c nude mice. When the tumor size reached˜250 mm3, mice were randomized by tumor volume into nine mice per group.The tumor bearing mice were treated with vehicle (9:1 PEG400:Ethanol) orCompound 1 for six doses with 12 hr dosing interval. The dosing volumewas 10 μL/g. The plasma samples and tumor samples were collected at 4, 8and 12 hr post final dose (N=4 mice per time point) for the subsequentmeasurement of compound level in plasma and tumor samples and of 2-HGlevel in the tumor samples by UPLC-MS-MS system.

For each assay, the total concentration of Compound 1 was determined inM and free Compound 1 concentration was calculated by multiplying thetotal Compound 1 concentration by 0.043 given that Compound 1 is 95.7%protein binding in mouse plasma. The percentage of 2-HG inhibition inindividual tumor sample in the treated groups was normalized to theaverage of 2-HG concentration in the vehicle group at the correspondingsampling time using the following calculation: % 2-HGinhibition=100*(A−B)/A, where A is the average of 2-HG concentration atthe corresponding sampling time, B is the 2-HG concentration in thetumor treated with given dose of Compound 1 and sacked at the givensampling time. The in vivo potency of Compound 1 for suppressing 2-HG intumor is calculated by plotting the percentage of 2-HG inhibitionagainst corresponding free Compound 1 concentration in tumor and fittingthe data with four-parameter logistic equation.

IDH1-R132H Mutation

IDH1-R132H mutation resulted in elevation of 2-HG level in hematologicaland solid cancers. HCT-116 IDH1-R132H/+ xenograft tumor was used toassess the in vivo potency of Compound 1 to suppress 2-HG in tumorlysates. The tumor bearing mice were randomized by tumor size intotwelve mice per group. The mice were treated with Compound 1 at 6.25,12.5, 25, or 50 mg/kg for six doses with dose interval of 12 hr. Theplasma and tumor samples were collected at 4, 8, and 12 hr post lastdose with four mice per time point. The Compound 1 concentration inplasma and tumor samples was analyzed by LC-MS method. The 2-HG level intumor samples was analyzed by LC-MS method. The percentage of 2-HGsuppression in tumor lysate at given dose of Compound 1 was thennormalized to 2-HG level in the vehicle control group. The dose and timedependent 2-HG inhibition by Compound 1 was observed in this study. Thedegree of 2-HG inhibition in tumor lysates was correlated with the freedrug concentration in the corresponding tumor lysate. The calculated invivo potency of Compound 1 to suppress 2-HG in tumor was 26.0 nM.

Upon correcting for unbound Compound 1 concentration, there was a goodcorrelation between the enzymatic, cellular 2-HG, and in vivo 2-HGpotencies of Compound 1 for IDH1-R132H mutant.

IDH1-R132C Mutation

IDH1-R132C mutation resulted in elevation of 2-HG level in hematologicaland solid cancers. HCT-116 IDH1-R132C/+ xenograft tumor was used toassess the in vivo potency of Compound 1 to suppress 2-HG in tumorlysates. The tumor bearing mice were randomized by tumor size into ninemice per group. The mice were treated with Compound 1 at 12.5, 25, or 50mg/kg for three doses with dose interval of 12 hr. The plasma and tumorsamples were collected at 4, 12, and 24 hr post last dose with threemice per time point. The Compound 1 concentration in plasma and tumorsamples was analyzed by LC-MS method. The 2-HG level in tumor sampleswas analyzed by LC-MS method. The percentage of 2-HG suppression intumor lysate at given dose of Compound 1 was then normalized to 2-HGlevel in the vehicle control group. The dose and time dependent 2-HGinhibition by Compound 1 was observed in this study. The degree of 2-HGinhibition in tumor lysates was correlated with the free drugconcentration in the corresponding tumor lysate. The calculated in vivopotency of Compound 1 to suppress 2-HG in tumor was 36.0 nM.

Upon correcting for unbound Compound 1 concentration, there was a goodcorrelation between the enzymatic, cellular 2-HG, and in vivo 2-HGpotencies of Compound 1 for IDH1-R132C mutant.

Results

Given the role of 2-HG in suppressing normal differentiation of mt-IDH1cells (Figueria et al., 2010; Saha et al., 2014), it is hypothesizedthat in order to reverse and maintain this effect, it is necessary toachieve a very high degree of target inhibition on a continuous basis.Therefore, in order to optimize the dosing schedule of Compound 1, itwas necessary to achieve sustained >90% 2-HG inhibition in mt-IDH1 invivo. For the HCT116-IDH1R132H xenograft assay, the 12 and 24 hour timepoints were chosen to reflect the compound level and corresponding 2-HGinhibition at the Ctrough of BID and QD dosing schedules. The 48 and 72hour time points were selected to investigate whether Compound 1 hadlong lasting effects on 2-HG inhibition. The free drug concentration ofCompound 1 at 12 hour post final dose is above the in vivo IC90 for alldoses, and a greater than 90% reduction of 2-HG levels in tumor wereachieved in each case. The free drug concentration decreased to 3-10×the in vivo IC50 at 24 hour post final dose, and the compound showed80-90% inhibition. There was less than 20 nM free drug concentration intumor at 48 and 72 hours after final dose, and at that point there wasless than 50% 2-HG inhibition in tumor samples, consistent with thereduced level of Compound 1. These data support the premise thatconstant target coverage by a significant margin is required to achievesustained 2-HG inhibition. This experiment also suggests that a BIDschedule is the preferred dosing regimen for Compound 1 in order tocontinuously achieve >90% 2-HG inhibition. This level of inhibition hasrecently been correlated to clinical efficacy with AG-221 in mt-IDH2harboring AML patients (Fan et al., 2014)).

The present disclosure contemplates, among other things, recognitionthat the total concentration (Ceff) of Compound 1 must be above 1652ng/mL in human patients in order to achieve 90% inhibition of 2-HG andabove 2000 ng/mL to achieve greater than 90% inhibition of 2-HG. Ceffwas determined using assays outlined in this Example. In two separatemouse experiments, HCT-116 IDH1-R132H/+ xenografts and HCT-116IDH1-R132C/+ xenograft tumor were used to assess the in vivo potency ofCompound 1 to suppress 2-HG in tumor lysates. Compound 1 concentrationin plasma and tumor samples and 2-HG level in tumor samples wasmeasured. The degree of 2-HG inhibition in tumor lysates was correlatedwith the free drug concentration in the corresponding tumor lysate (seeFIG. 4D). Given the role of 2-HG in suppressing normal differentiationof mt-IDH1 cells (Figueria et al., 2010; Saha et al., 2014), the presentdisclosure hypothesized that in order to reverse and maintain thiseffect, it is necessary to achieve a very high degree of targetinhibition with Compound 1 on a continuous basis. It was previouslyproposed that >90% inhibition of 2-HG correlates to clinical efficacy inmt-IDH2 harboring AML patients (FAN, B. et al., Evaluation of thepharmacokinetic/pharmocodynamic (PK/PD) relationships of an oral,selective, first-in-class, potent IDH1 inhibitor, AG-221, from a phase 1trial in patients with advanced IDH2 mutant positive hematologicmalignancies, Blood, 124: 3737, 6 pages (2014)). Using the curve fromFIG. 4D, the level of free drug concentration of Compound 1 wasdetermined to be 0.256 μM in order to achieve 90% inhibition of 2-HG.

Using a rapid equilibrium dialysis approach, the plasma protein bindingfor a human patient was determined to be 94.5%. (Waters, N.J., et al.(2008)). Validation of a rapid equilibrium dialysis approach for themeasurement of plasma protein binding. (J Pharm Sci 97(10): 4586-95.)Accordingly, the total concentration (Ceff) can be determined:0.256/((100−94.5)/100)=4.65 μM=1652 ng/mL.

Example 5: Pharmaceutical Compositions in an Oral Dosage Form ofCompound 1

A therapeutically effective amount of Compound 1 can be orallyadministered (e.g., an amount providing a steady state bloodconcentration greater than the IC₉₀ for 2-HG production for cancer cellshaving the IDH-1 R132 mutation disclosed herein, and less than an amountof about 7,200 ng/mL). For example, a therapeutically effective amountof Compound 1 can provide a steady state blood concentration of about2,000 ng/mL to 7,200 ng/mL throughout the course of treatment. Thetherapeutically effective amount can be up to about 150 mg of Compound 1in the solid form obtained by the method of Example 5, administered tothe patient BID on consecutive days, e.g., throughout a course oftreatment of at least about 6 months.

Step 1:

Compound 1 can be obtained using the chemical synthesis disclosed in PCTpatent application publication WO2016/044789A1 (published Mar. 24, 2016;filed Sep. 18, 2015) and summarized in FIG. 5. Examples 1, 21 and 25from WO2016/044789A1 are incorporated herein by reference, along withassociated analytical methods disclosed in the publicationWO2016/044789A1. Briefly, Compound 1 can be obtained using the method ofExample 25 (pages 92-93), based on the reaction of Intermediate II-1(obtainable using the method of Example 1 on pages 26-27) andIntermediate III-1 (obtainable using the method of Example 21 on pages79-82). Using this method, Compound 1 was obtained as a white solid (790mg). m.p. 262-264° C. ¹H NMR (300 MHz, DMSO-d₆) δ: 12.07 (s, 1H), 7.75(s, 1H), 7.73 (d, J=2.2 Hz, 1H), 7.51 (dd, J=8.6, 2.3 Hz, 1H), 7.31 (d,J=8.8 Hz, 1H), 6.97 (d, J=8.0 Hz, 1H), 6.93 (d, J=7.7 Hz, 1H), 5.95 (d,J=8.0 Hz, 1H), 4.68 (m, 1H), 3.58 (s, 3H), 1.50 (d, J=6.6 Hz, 3H). LCMS(Method 3): 100% pure @ 254 nm, Rt 10.78 min, m z 355, 357 [M+H]⁺. Thefiltrate and the colored fractions (TLC pure) from the second ISCO werecombined and treated with activated charcoal and filtered (until thefiltrate is colorless). The filtrate was then concentrated under reducedpressure on rotavap to remove dichlorometane until a lot of white solidprecipitated out. The white solid was collected by filtration and washedwith cold MeOH. It was then mixed with MeCN/H₂O (10 mL/25 mL) andlyophilized to afford the title compound 1-13 as a white solid (970 mg).m.p. 262-264° C. ¹H NMR (300 MHz, DMSO-d₆) δ: 12.06 (s, 1H), 7.75 (s,1H), 7.73 (d, J=2.5 Hz, 1H), 7.51 (dd, J=8.6, 2.3 Hz, 1H), 7.31 (d,J=8.8 Hz, 1H), 6.97 (d, J=8.0 Hz, 1H), 6.92 (d, J=8.0 Hz, 1H), 5.95 (d,J=8.0 Hz, 1H), 4.68 (m, 1H), 3.58 (s, 3H), 1.50 (d, J=6.9 Hz, 3H). LCMS(Method 3): 100% pure @ 254 nm, m/z 355, 357 [M+H]⁺. The total yield forcombined two batches is >67%.

Step 2:

Next, a solid form of Compound 1 can be obtained that is useful in anoral dosage form. Unless otherwise indicated, the studies herein wereperformed using a pharmaceutically acceptable solid form in an oraldosage form of Compound 1 that can be obtained by the method of Step 2of Example 5. All volumes are with respect to the quantity of Compound 1(v/w). Compound 1 obtained from Step 1 above is dissolved in 18 volumesof dichloromethane. The resulting solution is then concentrated underreduced pressure to approximately 5 volumes. To the mixture is added 5volumes of ethyl acetate. The mixture is concentrated under reducedpressure to 5 volumes. To the mixture is added an additional 5 volumesof ethyl acetate, and the mixture again concentrated under reducedpressure to 5 volumes. The mixture is diluted to 10 volumes with ethylacetate, and the mixture stirred at room temperature for 18 hours andthen cooled to 0° C. The mixture is stirred at 0° C. for 3 hours andthen filtered. The solids are rinsed with ethyl acetate and dried undervacuum (counterbalanced by nitrogen) at ambient temperature.

Step 3:

The oral dosage form of Compound 1 is a pharmaceutically acceptablesolid form of Compound 1 and can be obtained using the method of Example5 Step 2. The oral dosage form does not contain associated solvent or acounterion. In particular, the oral dosage form of Compound 1 can be acapsule comprising drug substance (Compound 1) blended with excipientsto improve powder flow and encapsulated in a Coni-Snap® hard gelatincapsule suitable for oral dosage in humans.

Compound 1 was formulated into capsules as summarized in Table 9A. Eachencapsulated drug product excipient meets the requirements of therespective current United States Pharmacopeia (USP) or NationalFormulary (NF) monograph. As permitted under EMA/CHMP/QWP/834816/2015,reference is made to the current compendial monographs in lieu ofinclusion of the current compendial specifications. The capsule shells,which consist of gelatin and about 2.9% w/w of titanium dioxide (E171),are specified according to the current compendial requirements for eachingredient. Each excipient may be obtained from qualified suppliers thatmeet the cited specifications, and may be accepted upon a suppliercertificate of analysis with minimal confirmatory identification testingupon receipt and periodic confirmation of supplier results.

TABLE 9A Dose Relative Strength Function Component weight² 50 mg orActive Compound 1 solid form, 33.00 150 mg Micronized¹ FillerMicrocrystalline Cellulose 61.12 NF/EP (Avicel PH101) DisintegrantCroscarmellose Sodium NF/EP 4.95 Lubricant Magnesium Stearate NF/EP 1.00Hard gelatin capsule shell, wt x size 2 or size 00, white opaque ¹20%excess Compound 1 solid form was micronized to obtain sufficientmaterial needed for the batch. ²As used herein, relative weights (or %w/w) are given as a percentage relative to the total weight of theformulation.

A pharmaceutically acceptable solid form of Compound 1 can be identifiedusing reflection X-ray powder diffraction (XRPD) pattern of Compound 1.High resolution X-ray Powder Diffraction experiments can be performedwith Panalytical X'Pert3 Powder XRPD on a Si zero-background holder. The2 theta position can be calibrated against Panalytical 640 Si powderstandard. Details of the XRPD method are listed below in Table 9B, withXRPD peaks reported as diffraction angles at 2 theta, with d-spacingmeasured in angstroms.

TABLE 9B Parameters for Reflection Mode X-Ray Wavelength Cu, kα, Kα1,(Å): 1.540598, Kα2 (Å): 1.544426 Kα2/Kα1 intensity ration: 0.50 X-Raytube setting 45 kV, 40 mA Divergence slit Automatic Scan mode ContinuousScan range (°2TH) 3°-40° Step size (°2TH) 0.0131 Scan speed (°/s 0.033

An example of a pharmaceutically acceptable solid form of Compound 1 isa solid form characterized by a reflection X-ray powder diffraction(XRPD) pattern comprising characteristic peaks at 6.3, 12.8, 13.8, 23.6,and 27.8 degrees±0.2° 2θ. A pharmaceutically acceptable solid form ofCompound 1 is a solid form characterized by characterized by an X-rayPowder Diffraction (XRPD), having diffractions at angles (2 theta±0.2)of 6.3, 12.8, 13.8, 23.6, and 27.8, corresponding to d-spacing(angstroms±0.2) of 14.0, 6.9, 6.4, 3.8, and 3.2, respectively. In someembodiments, a pharmaceutically acceptable solid form of Compound 1 canbe identified by X-ray Powder Diffraction (XRPD), having characteristicdiffractions at angles (2 theta±0.2) of 5.7, 6.3, 8.5, 10.6, 12.8, 13.8,17.3, 22.0, 22.8, 23.6, and 27.8. In some embodiments, apharmaceutically acceptable solid form of Compound 1 can be identifiedby X-ray Powder Diffraction (XRPD), having characteristic diffractionsat angles (2 theta±0.2) of 5.7, 6.3, 8.5, 10.6, 12.8, 13.8, 17.3, 22.0,22.8, 23.6, and 27.8, corresponding to d-spacing (angstroms±0.2) of15.4, 14.0, 8.4, 6.9, 6.4, 5.1, 4.0, 3.9, 3.8, and 3.2, respectively.

Example 6: Comparative Compounds Demonstrated Greater Disparity Between2-HG Inhibition in R132C and R132H IDH-1 Cells, Compared to Compound 1

The comparative activity of each of a series of mIDH-1 inhibitorcompounds including Compound 1 were measured using the cell based assayin Example 3. The ratio of the IC₅₀ values obtained from IDH-1 R132CHCT116 mutant cells (IC₅₀ μM g mean)/IC₅₀ values obtained from IDH-1R132H HCT116 mutant cells (IC₅₀ μM g mean) is provided in Table 10.Compound 1 had the lowest ratio among the tested compounds, indicatingnear equipotent activity of Compound 1 as measured with the R132C andR132H IDH-1 mutant cell assay of Example 3 (using the HCT 116 cellsdescribed in Example 3). Compound 1 showed comparative activityinhibiting 2-HG production from mIDH-1 R132C and R132H cell lines (usingthe assay of Example 3) that was within 5-fold, compared to moredisparate differences in activity ranging from about 8-fold to over 200fold (240) in comparative compound A-H in Table 10.

TABLE 10 Ratio of IC₅₀ measured for [IC₅₀ for R132C]/ Compound Structure[IC₅₀ for R132H] 1

4.5 A

8.0 B

8.0 C

8.5 D

9.0 E

11.0 F

26 G

30 H

240

Example 7: Determination of Central Nervous System MultiparameterOptimization (CNS MPO)

Central nervous system multiparameter optimization (CNS MPO) may be usedto prioritize compounds based on their likelihood to be brain-penetrant.The scoring function uses six key physicochemical properties (scoringeach parameter on a scale of zero to one) to arrive at a composite scoreranging from 0-6. Higher CNS MPO scores are correlated with a higherlikelihood of a compound being brain-penetrant. The reported CNS MPOscores were calculated following the method reported in: Wager, T. T.,Hou, X., Verhoest, P. R., and Villalobos, A. (2010) Moving beyond rules:The development of a central nervous system multiparameter optimization(CNS MPO) approach to enable alignment of druglike properties. ACS Chem.Neurosci. 1, 435-449.

A summary of the MPO scores for several mIDH inhibitors are found inTable 11: Table 11

TABLE 11 IDH1 R132H IDH1 CNS IC₅₀ R132C MPO Predicted Cpd ID Structure(μM)* IC₅₀ (μM) Score^(a) BBB+^(b) BBB+^(c) AG-120¹

0.012 0.013 3.69 No No AG-881²

>0.022 >0.022 3.97 Yes Yes IDH305³

0.027 0.028 4.15 Yes Yes IDH889⁴

0.020 0.072 4.50 Yes Yes GSK321⁵

0.0048 0.0038 2.89 nd No Bay 1436032⁶

0.015 0.015 3.05 nd No Compound 1^(d)

+++ (0.0212) +++ (0.1138) 5.22 Yes Yes I-1

+++ nd 5.30 nd Yes I-2

++ + 5.35 nd Yes I-3

++ + 5.42 nd Yes I-5

++ + 5.29 nd Yes I-6

++ + 5.29 nd Yes I-11

++ + 5.27 nd Yes I-20

+++ ++++ 4.93 nd Yes I-22

+++ ++++ 4.93 nd Yes I-23

+++ ++++ 3.97 nd Yes I-25^(e)

+++ nd 3.97 nd Yes I-26

++++ ++++ 3.75 nd No I-27

++++ ++++ 4.38 nd Yes I-29

++++ ++++ 4.46 nd Yes *For Compound 1 and Compounds I-1 through I-29,W02016/044789 defines IC₅₀ values for IDH1 R132H as ″++++″: <0.01 μM;″+++″: between 0.01 μM and 0.1 μM; ″++″: from 0.1 μM to 1 μM; and IC₅₀values for IDH1 R132C as ″++++″: <0.1 μM; ″+++″: between 0.1 μM and 1μM; ″++″: from 1 μM to 10 μM; and ″+″: >10 μM ^(a)CNS MPO scorecalculated based on the method described in T. Wager, ACS Chem.Neurosci. (2010), 1, 435-449. ^(b)Literature reported data ^(c)PredictedBBB+: CNS MPO score >3.8 ^(d)W02016/044789 also reports Compound 1 (asI-13) as having activity in HCT116 mutant IDH1 R132H and R132C cells as+++ and +++, respectively. ^(e)W02016/044789 also reports 1-25 as havingactivity in HCT116 mutant IDH1 R132H and R132C cells as ++++ and ++++,respectively. ¹Popovici-Muller, J., et al. Discovery of AG-120(Ivosidenib): A First-in-Class Mutant IDH1 Inhibitor for the Treatmentof IDH1 Mutant Cancers. ACS Med. Chem. Lett., 2018, 9(4), 300-305. ²Yen,K. , et al. Abstract B126: AG-881, a brain penetrant, potent, pan-mutantIDH (mIDH) inhibitor for use in mIDH solid and hematologic malignancies,AACR-NCI-EORTC International Conference: Molecular Targets and CancerTherapeutics; October 26-30, 2017; Philadelphia, PA. ³Cho, Y. S. , etal. Discovery and evaluation of clinical candidate IDH305, a brainpenetrant mutant IDH1 Inhibitor. ACS Med. Chem. Lett. 2017, 8,1116-1121. ⁴Levell, J. R. , et al. Optimization of3-pyrimidin-4-yl-oxazolidin-2-ones as allosteric and mutant specificinhibitors of IDH1. ACS Med. Chem. Lett. 2017, 8, 151-156.⁵Okoye-Okafor, U. C., et al. New IDH1 mutant inhibitors for treatment ofacute myeloid leukemia. Nat. Chem. Biol. 2015, 11, 878-886. ⁶Pusch, S. ,et al. Pan-mutant IDH1 inhibitor BAY 1436032 for effective treatment ofIDH1 mutant astrocytoma in vivo. Acta Neuropathologica 2017, 133(4),629-644.

Example 8: Determination of Predicted C_(brain) Ratio of mIDH Inhibitors

The distribution of Compound 1, AG-120 or AG-881 into the brain wasmeasured ex-vivo, individually, in Sprague Dawley rats (n=4/molecule)following a 6 hour intravenous infusion of a 7.5 mg/kg dose. Braintissue and plasma samples were collected at the end of the infusion timeand were processed for bioanalysis via tandem HPLC-mass spectrometryanalysis (LCMS) to determine the total amount of compound present. Inparallel, brain and plasma samples were subjected to equilibriumdialysis as described by N.J. Waters et. al (J. Pharm. Sci. (2008)97(10):4586-95) to determine the unbound fraction (Table 12). The braindistribution or partitioning coefficient (Kpuu) was then calculated asthe ratio of the unbound concentration of drug in brain (Fu, brain) tothe unbound concentration of drug in plasma (Fu, plasma). Similarly, allcalculations of effective plasma concentrations in rodents or humanswere conducted using the unbound/free fraction measured for eachmolecule in each species using conventional equilibrium dialysis asdescribed by Waters.

To determine the projected effective free concentration in humans, theplasma concentrations in tumor bearing mice were measured using 90%inhibition in tumors (IC₉₀) of the biomarker 2-HG, as the minimaleffective concentration to provide therapeutic benefit. In tumor bearingmice studies, the unbound plasma concentration at IC₉₀ was determined tobe 90.7 ng/mL (Table 12). In human clinical trials, a dose of 150 mg BIDfor Compound 1 showed a mean plasma concentration (C_(free, avg)) of 171ng/mL, which when corrected by the expected brain partitioning(Kpuu=0.42) and free fraction in brain (Fu, brain=0.05) provides anestimate of 3.6 ng/mL unbound concentration in brain. The targeteffective concentration in human brain based on mouse models (to achieveIC₉₀) is 1.91 ng/mL. Hence, Compound 1 partitions into the brain by2-fold greater than projected levels required to achieve therapeuticbenefit.

TABLE 12 Parameters Compound (ng/mL) 1 AG-120 AG-881 Brain Distribution(Kp, uu rat) 0.4 0.01 0.5 *Predicted C_(eff, brain, fu) 1.9 0.7 0.5Predicted Clinical 150 mg 500 mg QD**: 50 mg QD: 10 mg QD:C_(Avg)_Brain, fu BID: 4 0.4 0.03 0.01 Predicted Cbrain Ratio 2.0 0.60.06 0.02 (C_(avg)_Brain, fu/C_(eff)_Brain, fu) *Calculated braindistribution of Ceff, fu plasma in mice **Based on Cycle 1 PK, 2-folddecrease over time

Example 9—Compound 1 Penetrates the Blood Brain Barrier in Murine Models

The blood brain barrier penetration and free brain exposure of Compound1 was investigated in the male CD-1 mouse (FIG. 6). The brain exposureof Compound 1 following oral dosing (5 mg/kg) was evaluated. Following a5 mg/kg oral dose in CD1 mice, the brain to plasma ratio of Compound 1was found to be 0.24 suggesting that the compound has reasonable brainpenetration characteristics, and that at higher doses Compound 1 wouldhave the potential to achieve therapeutic brain levels.

This was confirmed by dosing at 100 mg/kg (FIG. 7), where the brain toplasma ratio was determined to be 0.38. Importantly, following a single100 mg/kg PO dose, the free Cmax concentration of Compound 1 was about200 nM (approximately ten fold IC50), dropping to about 130 nM (aboutsix fold IC₅₀) at the 7 hour time point, which is consistent withexposures that produced >90% suppression of 2-HG in both HCT 116 (IDH-1R132H) and HCT 116 (IDH-1 R132C) xenograft PK-PD studies. Based onassessment in the mouse, Compound 1 crosses the blood-brain barrier toreach free concentration levels in the brain consistent withpharmacological activity. An oral 100 mg/kg dose gives a free Cmax inbrain of 200 nM, dropping to about 130 nM at the 7 hr time point.

Example 10: Testing Compound 1 in Cynomolgus Monkey Models

Animal Acquisition and Acclimation

A total of 22 male and 22 female experimentally naïve cynomolgusmonkeys, approximately 2 years and 7 months to 3 years and 11 months ofage at transfer, were transferred from the stock colony. The animalswere originally received from Worldwide Primates Inc. Animals werequarantined upon arrival and quarantine activities, includingintrapalpebral tuberculin skin tests, were performed. The animals wereconsidered suitable prior to being released from quarantine. Duringacclimation as part of the stock colony, the monkeys were examined by astaff veterinarian, weighed, and observed daily with respect to generalhealth and any signs of disease.

Randomization, Assignment to Study, and Maintenance

Using a standard, by weight, measured value randomization procedure, 20male and 20 female animals (weighing 2.50 to 3.15 kg and 2.35 to 3.20kg, respectively, at randomization) were assigned to the control and 3treatment groups. Animals assigned to study had body weights within +20%of the mean body weight for each sex. Extra animals obtained for thestudy, but not placed on study, were transferred to the stock colony.Each animal was assigned an animal number to be used in the datacollection system and was implanted with a microchip bearing a uniqueidentification number. Each animal was also identified by a permanenttattoo with the vendor animal number. The individual animal number,implant number, tattoo number and study number comprised a uniqueidentification for each animal. Each cage was identified by the animalnumber, study number, group number, and sex.

Administration

Male and female cynomolgus monkeys were assigned to four groups. Animalswere assigned to the study as indicated below in Table 13. Six animalsper sex in Group 1 were administered vehicle control article only. Fouranimals per sex in Groups 2 and 3, and 6 animals per sex in Group 4 wereadministered test article. Animals in Groups 2 through 4 were dosed for28 days. 2 animals/sex in Groups 1 & 4 were assigned for 28-day recoveryassessment. Animals were dosed via oral gavage twice daily, every 12hours, at a volume of 10 mL/kg/dose (20 mL/kg/day). Animals in Groupstwo through four were administered 30, 100/50, or 300/200/100 mg/kg/day(15, 50/25, or 150/100/50 mg/kg/dose) respectively. The dose levels werelowered for Group 3 and Group 4 animals based clinical observationsduring the dosing phase. The vehicle control article was KolliphorEL:Tween 80 (70:30, v/v). Animals designated for recovery sacrifice (2animals/sex in Groups 1&4) underwent 4 weeks of recovery assessment.

TABLE 13 Dose Dose Level Dose Level Dose Volume Conc. Number of AnimalsGroup (mg/kg/day) (mg/kg/dose) (mL/kg/dose) (mg/mL) Male Female 1 0^(a) 0 10 0  6^(b)  6^(b) 2 30   15 10 1.5 4 4 3 100/50^(c)  50^(c) 10 5 4 44 300/200/100^(d) 150/100^(d) 10 15/10^(d)  6^(b)  6^(b) ^(a)Animals inGroup 1 received the vehicle, Kolliphor EL:Tween 80 (70:30, v/v).^(b)Two animals/sex were maintained for a 28-day recovery period.^(c)Beginning on Day 14, the 50 mg/kg/dose twice daily (BID) dose (100mg/kg/day) was reduced to 50 mg/kg/dose once daily (50 mg/kg/day) forthe remainder of the study. ^(d)Animals at 300 mg/kg/day were placed ona dosing holiday beginning with the second dose on Days 4 through Day11. The 150 mg/kg/dose twice daily (BID) dose (300 mg/kg/day) wasreduced to 100 mg/kg/dose twice daily (200 mg/kg/day) at a concentrationof 10 mg/mL for Days 12 and 13. Beginning on Day 14, the 100 mg/kg/dosetwice daily (BID) dose (200 mg/kg/day) was reduced to 100 mg/kg/doseonce daily (100 mg/kg/day) for the remainder of the study.

Assessment of toxicity was based on mortality, clinical observations,body weights, food consumption, ophthalmic observations,electrocardiographic (ECG) measurements, and clinical and anatomicpathology. Blood samples were collected for toxicokinetic evaluations.

Electrocardiographic Assessment

With the exception of one animal in the high dose group, there was noeffect of Compound 1 on qualitative ECG parameters. Frequent ventricularpremature complexes (Day 1, 3-4 hours post-dose) and ventriculartachycardia (Day 28 pre-dose and 3-4 hours post-dose) were observed inone animal following administration of the 300/200/100 mg/kg/day dose.As these ventricular arrhythmias are not considered normal variants andwere observed following the high dose, these findings may have been testarticle-related. Noteworthy effects on quantitative ECG parameters werelimited to QTc interval duration. When evaluated statistically by sex,mean QTc interval duration was longer (vs. concurrent vehicle controlvalue) in 300/200/100 mg/kg/day males at the Day 1 post-dose intervaland at the Day 28 pre-dose and post-dose intervals and in 100/50mg/kg/day females at the pre-test and Day 28 intervals. The differencein 100/50 mg/kg/day females was not considered to be testarticle-related as it was present prior to initiation of test articleadministration. In 300/200/100 mg/kg/day males, the increase in mean QTcinterval duration may have been test article-related as it was observedat the highest dose level and exhibited a progressive increase withcontinued dosing. The magnitude of change from pretest values was mildto moderate (Day 1 post-dose: 7.14%; Day 28 pre-dose: 7.73%; Day 28post-dose: 10.6%). Compared to pretest values, the magnitude of theincrease in QTc interval duration in males at the Day 28 post-doseinterval was 10.61%, which approximates the 10% change seen in theJapanese QT PRODACT studies (Ando, K., Hombo, T., Kanno, A., Ikeda, H.,et al. QT PRODACT: in vivo QT assay with a conscious monkey forassessment of the potential for drug induced QT interval prolongation. JPharmacol Sci. 2005; 99(5):487-500) of drugs known to cause QTprolongation in people. The effect on QTc interval duration wasreversible, not being present at the recovery interval. The thresholdCmax plasma concentration in a monkey that experienced an average groupQTc prolongation of 10.6% was 7840 ng/mL.

Conclusion

Cynomolgus monkeys tolerated oral doses of Compound 1 twice daily at 15mg/kg/dose (30 mg/kg/day) and once daily at 50 mg/kg/day. Compound1-related post-mortem findings at the end of the treatment periodincluded macroscopic findings of black discoloration in the liver of 3/4males and 2/4 females at 300/200/100 mg/kg/day, which correlated tomultinucleated cells in the sinusoids. Lower thymus weights, whichcorrelated to an increased incidence and/or severity of lymphoiddepletion, were observed in Compound 1-treated animals and wereconsidered secondary to stress and ill-health. Microscopically, Compound1 was associated with multinucleated cells in the sinusoids of the liverand mucosal atrophy of the intestinal tract in males and females at100/50 and/or 300/200/100 mg/kg/day. The histological changes in theliver were considered adverse and correlated with a number of the serumchemistry changes. At the recovery interval, intestinal changes wereabsent, suggesting reversibility, and multinucleated cells in thesinusoids of the liver were decreased in severity, indicating partialrecovery. Test article-related increase in the mean QTc level wasobserved at the highest dose level 300/200/100 mg/kg/day in the malemonkeys. The threshold plasma Cmax concentration in a monkey thatexperienced an average group QTc prolongation of 10.6% was 7840 ng/mL.

The no-observed-adverse effect-level (NOAEL) for Compound 1 wasconsidered to be 30 mg/kg/day (15 mg/kg/dose BID). Systemic exposure(Cmax and AUCTlast; combined-sex) at the NOAEL on Day 28 was 2490 ng/mLand 23600 ng-h/mL, respectively. Based on the expected reversibility ofadverse hepatic findings, 50 mg/kg/day was considered the highestnonseverely toxic dose (HNSTD). Systemic exposure (Cmax and AUCTlast;combined-sex) at the HNSTD on Day 28 was 4350 ng/mL and 53900 ng-h/mL,respectively.

Example 11: Compound 1 Induces Mutation Clearance in Patients with AcuteMyeloid Leukemia (AML) or Myelodysplastic Syndrome (MDS) Treated inPhase 1 Dose Escalation and Expansion Study

Isocitrate dehydrogenase 1 mutations (mIDH-1) occur in 7-14% of AMLpatients (“pts.”) and 3% of MDS pts. Compound 1 is a highly potent,selective small molecule inhibitor of mIDH-1 without anticipated CYP orQTc liabilities at the recommended phase 2 dose. This study evaluatedthe safety, pharmacokinetics (PK), pharmacodynamics (PD) and clinicalactivity of the novel anticancer drug Compound 1, administered topatients with relapsed or refractory acute myeloid leukemia (AML) ormyelodysplastic syndrome (MDS). Compound 1 is a potent, selective,orally bioavailable, small-molecule inhibitor of mutated isocitratedehydrogenase 1 (IDH1) and is intended for the treatment of patientsharboring IDH1 mutations, in both hematologic and solid tumors.

The presence of mutations at codon 132 in IDH1 imparts a neomorphicactivity to the enzyme, resulting in the production of the“oncometabolite” (R)-2-hydroxyglutarate (2-HG), which has pleotropicroles in tumorigenesis. Studies in genetically engineered mouse modelsand models derived from cancer patient samples support the hypothesisthat mutated IDH1 produces 2-HG, the downstream effects of which causeepigenetic changes that consequently block the proper differentiation ofprogenitor cells and lead to cancer. These data support the therapeuticrationale that inhibition of mutated IDH1 will lower(R)-2-hydroxyglutarate (2-HG) levels and restore normal cellulardifferentiation.

Inclusion Criteria

To be considered eligible to participate in this study, a patient metthe inclusion criteria listed below:

-   -   1. Pathologically proven AML (except acute promyelocytic        leukemia with the t(15; 17) translocation) or intermediate risk,        high risk or very high risk MDS as defined by the World Health        Organization (WHO) criteria or Revised International Prognostic        Scoring System (IPSS-R) harboring IDH1-R132 mutations, and one        of the following based on enrollment stage or treatment cohort:        -   a. Single Agent Phase 1 Cohorts including            Dose-Escalation/Dose-Expansion: AML/MDS either R/R to            standard therapy, or for whom standard treatments are            contraindicated        -   b. Combination (Compound 1+azacitidine) Phase 1            Dose-Escalation/Dose-Expansion (patients must meet one of            the following):            -   i. Patients with AML that is either R/R to standard                therapy, or for whom standard treatments are                contraindicated            -   ii. Patients with MDS that is either R/R to standard                therapy, or are treatmentnaïve, who are eligible for                azacitidine therapy        -   c. Combination (Compound 1+cytarabine) Phase 1            Dose-Escalation/Dose-Expansion Cohort: Patients ≥60 years            with treatment-naïve AML for whom standard treatments are            contraindicated        -   d. Phase 2 Cohort 1 (Single Agent) only: AML R/R to standard            therapy        -   e. Phase 2 Cohort 2 (Single Agent) only: AML in morphologic            CR/CRi after prior therapy (+/−HSCT) with residual IDH1-R132            mutation (≥0.01%) detected in the bone marrow        -   f. Phase 2 Cohort 3 (Single Agent) only: R/R AML/MDS that            have been previously treated with IDH1 inhibitor therapy AND            for whom standard treatments are contraindicated        -   g. Phase 2 Cohort 4 (Compound 1+Azacitidine) only: Patients            <60 years old with R/R AML/MDS with no prior hypomethylating            agent therapy AND no prior IDH1 inhibitor therapy        -   h. Phase 2 Cohort 5 (Compound 1+Azacitidine) only: R/R            AML/MDS that have inadequately responded to or have            progressed on prior treatment with a hypomethylating agent        -   i. Phase 2 Cohort 6 (Compound 1+Azacitidine) only: R/R            AML/MDS that have been previously treated with a single            agent IDH1 inhibitor as their last therapy prior to study            enrollment        -   j. Phase 2 Cohort 7 (Single Agent) only: Treatment naïve AML            patients for whom standard treatments are contraindicated        -   k. Phase 2 Cohort 8 (Compound 1+Azacitidine) only: Treatment            naïve AML patients who are candidates for azacitidine as a            first line treatment            -   (Note for Phase 2 Cohort 7 and Phase 2 Cohort 8:                Treatment naïve is defined as no prior treatment for                AML. Patients may have received a prior treatment for                another hematologic malignancy.)    -   2. Patients must have documented IDH1-R132 gene-mutated disease        as evaluated by the site    -   3. Patients ≥18 years old    -   4. Eastern Cooperative Oncology Group (ECOG) performance status        of 0 to 2    -   5. Signed informed consent prior to beginning study and        undergoing procedures    -   6. No prior solid organ allograft    -   7. Acceptable liver function:        -   a. Bilirubin ≤2 times upper limit of normal (ULN) (≤3 times            ULN in patients with Gilbert Syndrome)        -   b. Aspartate transaminase (AST, also referred to as SGOT),            alanine transaminase (ALT, also referred to as SGPT) and            alkaline phosphatase (ALP)≤3 times ULN    -   8. Acceptable renal function:        -   a. Serum creatinine ≤1.5 times ULN or calculated creatinine            clearance ≥50 mL/min (Cockcroft and Gault 1976)    -   9. Recovery from the non-hematologic toxic effects of prior        treatment to Grade ≤1, or baseline value according to NCI CTCAE        classification (excluding infertility, alopecia, or Grade 1        neuropathy)    -   10. Baseline QTcF ≤450 msec (average of the QTcF values of        screening triplicate ECGs) Note: This criterion does not apply        to patients with a bundle branch block (BBB); for patients with        BBB, a cardiology consult is recommended to ensure that QTcF is        not prolonged.    -   11. Negative serum pregnancy test if female of childbearing        potential    -   12. For fertile men and women, agreement to use highly effective        contraceptive methods for the duration of study participation        and 90 days after the last dose of study medication    -   13. Agreement for male patients not to donate sperm and for        female patients of childbearing potential not to donate ova        during the study and for 90 days after the final dose of study        drug    -   14. Phase 2 Cohorts 1-8 (SA and combination) only: Pre-treatment        peripheral blood and bone marrow aspirate available for        retrospective central confirmation of IDH1-R132 mutation is        required. Note: Central confirmation of IDH1-R132 mutation is        not required for study enrollment.        Exclusion Criteria

To be eligible for entry into the study, the patient did not meet any ofthe exclusion criteria listed below:

-   -   1. Phase 1 Single Agent Dose-escalation/Dose-expansion Cohorts        and Phase 2 Cohorts 1, 4, 5, 7 and 8 only: Patients who have        been treated with an IDH1 targeted therapy are excluded    -   2. Phase 2 Single Agent Cohorts 1-3 and 7 only: Patients with        IDH2 mutation detection at baseline or history of IDH2m        inhibitor treatment are excluded    -   3. History of prior malignancy unless disease-free for ≥12        months or considered surgically cured; patients with nonmelanoma        skin cancers or with carcinomas in situ are eligible regardless        of the time from diagnosis (including concomitant diagnoses)    -   4. Patients with symptomatic central nervous system (CNS)        metastases or other tumor location (such as spinal cord        compression, other compressive mass, uncontrolled painful        lesion, bone fracture, etc.) necessitating an urgent therapeutic        intervention, palliative care, surgery or radiation therapy    -   5. Patients with previous allogeneic HSCT, if they meet any of        the following criteria: <100 days from time of HSCT; active        acute or chronic graft vs. host disease (GvHD); or receiving        immunosuppressive therapy as treatment or prophylaxis against        GvHD Note: Doses <20 mg methylprednisolone (or its equivalent)        daily are not an exclusion criterion.    -   6. Treatment with radiation therapy, major surgery (requiring        general anesthesia) within one month prior to study drug dosing    -   7. Treatment with chemotherapy or small molecule anticancer        therapeutic within five half-lives of the agent or within 21        days if the half-life is unknown. Patients reenrolling in Cohort        6 after relapse/progression on Cohort 1 are exempt from this        washout requirement (i.e. can continue Compound 1 treatment        until re-enrollment) 8. Treatment with an anticancer therapeutic        antibody less than four weeks before first dose of study drug    -   9. Treatment with other experimental therapies or participation        in another clinical trial within a period of time that is less        than the cycle length or within 21 days prior to starting study        drug, whichever is shorter    -   10. Patients unable to swallow oral medications, or patients        with gastrointestinal conditions (e.g., malabsorption,        resection, etc.) deemed by the Investigator to jeopardize        intestinal absorption    -   11. Congestive heart failure (New York Heart Association Class        III or IV) or unstable angina pectoris; previous history of        myocardial infarction within one year prior to study entry,        uncontrolled hypertension, or uncontrolled arrhythmias    -   12. Patients with a family history of QT prolongation    -   13. Concomitant medication(s) known to cause Torsades de Pointes        (TdP) initiated less than the duration required to reach        steady-state plasma concentration (approximately five        half-lives) before first dose of study drug (medications used as        needed [PRN] (e.g. Zofran) are exempt)    -   14. Concurrent treatment with chronic corticosteroids except if        chronic treatment with <20 mg of methylprednisolone daily or        equivalent (pulse steroids for treatment or prophylaxis are        allowed [e.g., for transfusion or medication reactions])    -   15. Known HIV positivity    -   16. Active, uncontrolled bacterial, viral, or fungal infections,        requiring systemic therapy (prophylactic systemic antimicrobials        permitted)    -   17. Uncontrolled disease-related metabolic disorder (e.g.,        hypercalcemia)    -   18. Pregnant or nursing women or women of childbearing potential        not using highly effective contraception; male patients not        using highly effective contraception. Note: Women of        childbearing potential and men must agree to use highly        effective contraception prior to study entry and for the        duration of study participation and 90 days after. Should a        woman become pregnant or suspect she is pregnant while        participating in this study, she should inform her treating        physician immediately.    -   19. Serious nonmalignant disease (e.g., hydronephrosis, liver        failure, or other conditions) that could compromise protocol        objectives in the opinion of the Investigator and/or the Sponsor    -   20. Unwillingness or inability to comply with procedures either        required in this protocol or considered standard of care    -   21. Medical, uncontrolled disease-related metabolic disorder,        psychiatric, cognitive, or other conditions that may compromise        the patient's ability to understand the patient information,        give informed consent, comply with the study protocol, or        complete the study    -   22. History of severe allergic reaction to azacitidine (if        patient enrolling into azacitidine combination cohort) or        low-dose cytarabine (if patient enrolling into cytarabine        combination cohort)    -   23. Prisoners or patients who are involuntarily incarcerated or        are compulsorily detained for treatment of either a psychiatric        or physical (e.g. infectious disease) illness. Note: Under        certain specific circumstances, a person who has been imprisoned        may be included or permitted to continue as a patient, if local        regulations permit. Strict conditions apply and approval is        required.        Treatment/Intervention Plan

Compound 1 was administered as a single agent or in combination withazacitidine or cytarabine. Compound 1 was supplied as 50 mg or 150 mgcapsules and was administered per the protocol defined frequency anddose level. Azacitidine was administered per site's standard of care.Cytarabine will be administered per site's standard of care.

The Phase 1 stage of the study was split into 2 distinct parts: a doseescalation part, which utilized an open-label design of Compound 1(single agent), or Compound 1+azacitidine (combination agent), orCompound 1+cytarabine (combination agent) administered via one or moreintermittent dosing schedules followed by a dose expansion part. Thedose expansion part enrolled patients in up to 5 expansion cohorts,exploring single-agent Compound 1 activity as well as combinationactivity with azacitidine or cytarabine. Patients received only a singledose of study drug (single-agent arm and combination arm) on Cycle 1Day 1. Following the completion of the relevant Phase 1 cohorts, Phase 2began enrollment. Patients were enrolled across 6 different cohorts,examining the effect of Compound 1 (as a single agent) and Compound 1with azacitidine (combination) on various AML/MDS disease states.Conditions examined include acute myeloid leukemia (also known as acutemyelogenous leukemia) and myelodysplastic syndrome. FIG. 8A and FIG. 8Bsummarize certain cohorts from a phase 1 study for mIDH1 AML and MDS.

TABLE 14 Arms and Interventions of Phase 1 Trial. Arms AssignedInterventions Experimental: PH1 Dose Escalation & Drug: Compound 1Expansion Compound 1 Compound 1 is supplied as 50 mg or 150 mg capsulesand is administered per the protocol defined frequency and dose levelExperimental: PH1 Esc. and Exp. Drug: Compound 1 Compound 1 +Azacitidine Compound 1 is supplied as 50 mg or 150 mg capsules and isadministered per the protocol defined frequency and dose level Drug:Azacitidine (Vidaza) Azacitidine is administered per site's standard ofcare Experimental: PH1 Esc. and Exp. Drug: Compound 1 Compound 1 +Cytarabine Compound 1 is supplied as 50 mg or 150 mg capsules and isadministered per the protocol defined frequency and dose level Drug:Cytarabine Low-dose cytarabine are administered per site's standard ofcare Experimental: PH2 Cohort 1 Drug: Compound 1 Compound 1 Single AgentRelapsed Compound 1 is supplied as 50 mg or 150 mg or Refractory (R/R)AML capsules and is administered per the protocol defined frequency anddose level Experimental: PH2 Cohort 2 Drug: Compound 1 Compound 1 SingleAgent Compound 1 is supplied as 50 mg or 150 mg AML/MDS in morphologiccomplete capsules and is administered per the remission or completeremission protocol defined frequency and dose level with incompleteblood count recovery (CR/CRi) after cytotoxic- containing inductiontherapy with residual IDH-R132 mutation Experimental: PH2 Cohort 3Compound 1 Drug: Compound 1 Single Agent Compound 1 is supplied as 50 mgor 150 mg R/R AML/MDS, previously treated capsules and is administeredper the with an IDH1 inhibitor protocol defined frequency and dose levelExperimental: PH2 Cohort 4 Compound 1 + Drug: Compound 1 AzacitidineCompound 1 is supplied as 50 mg or 150 mg R/R AML/MDS that are naïve tocapsules and is administered per the prior hypomethylating therapy andprotocol defined frequency and dose level IDH1 inhibitor therapy Drug:Azacitidine (Vidaza) Azacitidine is administered per site's standard ofcare Experimental: PH2 Cohort 5 Drug: Compound 1 Compound 1 +Azacitidine Compound 1 is supplied as 50 mg or 150 mg R/R AML/MDS thathave inadequately capsules and is administered per the responded or haveprogressed protocol defined frequency and dose level immediatelypreceeding hypomethyl- Drug: Azacitidine (Vidaza) ating therapyAzacitidine is administered per site's standard of care Experimental:PH2 Cohort 6 Compound 1 + Drug: Compound 1 Azacitidine Compound 1 issupplied as 50 mg or 150 mg R/R AML/MDS that have been previouslycapsules and is administered per the treated with single-agent IDH1protocol defined frequency and dose level inhibitor therapy as theirlast therapy Drug: Azacitidine (Vidaza) prior to study enrollmentAzacitidine is administered per site's standard of care

Following the completion of Phase 1, Phase 2 enrollment began. Patientswere enrolled across 6 different cohorts, examining the effect ofCompound 1 (as a single agent) and Compound 1+azacitidine (combination)on various AML/MDS disease states. The Phase 2 cohorts are summarized inTable 15 below:

TABLE 15 Co- Patient hort Population Intervention I Patients withrelapsed or Recommended phase II dose refractory (R/R) AML (“RP2D”) ofCompound 1 as a single-agent II Patients with AML/MDS in RP2D ofCompound 1 morphologic complete as a single-agent remission or completeremission with incomplete blood count recovery (CR/CRi) after cytotoxic-containing induction therapy with residual IDH-R132 mutation IIIPatients with R/R AML/MDS, RP2D of Compound 1 previously treated with anas a single-agent IDH1 inhibitor IV Patients with R/R AML/MDS RP2D ofCompound 1 that are naïve to prior in combination with azacitidinehypomethylating therapy and IDH1 inhibitor therapy V Patients with R/RAML/MDS RP2D of Compound 1 that have inadequately in combination withazacitidine responded or have progressed immediately precedinghypomethylating therapy VI Patients with R/R AML/MDS RP2D of Compound 1that have been previously in combination with azacitidine treated withsingle-agent IDH1 inhibitor therapy as their last therapy prior to studyenrollmentPrimary Outcome Measures

The outcome of the study can be evaluated using the following criteria:

-   -   1. Maximum Tolerated Doses (MTDs) or Maximum Evaluated Doses        (MEDs) [Phase 1]. Time Frame: Within first 4 weeks of treatment.    -   2. Number of Participants with a Dose Limiting Toxicity (DLT)        [Phase 1]. Time Frame: Within first 4 weeks of treatment. DLT        Criteria can include:        -   ≥Gr 3 non-hematologic toxicity or laboratory finding        -   Gr 4 hematologic toxicity by Day 42 in absence of disease        -   Inability to tolerate at least 75% of Cycle 1 treatment    -   3. Doses recommended for future studies [Phase 1]. Time Frame:        Within first 4 weeks of treatment.    -   4. Complete Response (CR, CRi, MLFS, Marrow CR) Rate of Compound        1 as a single-agent or in combination with Azacitidine in        patients with AML/MDS [Phase 2]. Time Frame: As per IWG Response        Assessment Guidelines for AML and MDS based on investigator's        assessment through study completion, e.g. modified IWG AML        2003/MDS 2006.        Secondary Outcome Measures

The outcome of the study can also be evaluated using the followingcriteria:

-   -   1. Area under the plasma concentration versus time curve (AUC)        [Phase 1 and Phase 2]. Time Frame: Blood samples for PK analysis        collected at multiple visits during the first 60 days of        treatment and on day 1 of all cycles following the first 30        days.    -   2. Peak Plasma Concentration (Cmax) [Phase 1 and Phase 2]. Time        Frame: Blood samples for PK analysis collected at multiple        visits during the first 60 days of treatment and on day 1 of all        cycles following the first 30 days.    -   3. Time of peak plasma concentration (Tmax) [Phase 1 and Phase        2]. Time Frame: Blood samples for PK analysis collected at        multiple visits during the first 60 days of treatment and on day        1 of all cycles following the first 30 days.    -   4. Time for half of the drug to be absent in blood stream        following dose (T 1/2) [Phase 1 and Phase 2]. Time Frame: Blood        samples for PK analysis collected at multiple visits during the        first 60 days of treatment and on day 1 of all cycles following        the first 30 days.    -   5. Rate at which drug is removed from blood stream (CL/F) [Phase        1 and Phase 2]. Time Frame: Blood samples for PK analysis        collected at multiple visits during the first 60 days of        treatment and on day 1 of all cycles following the first 30        days.    -   6. Rate of drug distribution within the blood stream (Vd/F)        [Phase 1 and Phase 2]. Time Frame: Blood samples for PK analysis        collected at multiple visits during the first 60 days of        treatment and on day 1 of all cycles following the first 30        days.    -   7. Reduction of 2-HG levels in plasma [Phase 1 and Phase 2].        Time Frame: Blood samples for PK/PD analysis collected at        multiple visits during the first 60 days of treatment and on day        1 of all cycles following the first 30 days.    -   8. Evidence of antileukemic or antimyelodysplastic activity of        Compound 1 as determined by complete response (CR), CRi        (complete remission with incomplete hematologic recovery),        morphologic leukemia-free state (MLFS), Marrow CR, partial        remission (PR), and stable disease (SD) as a single-agent or in        combination with azacitidine or cytarabine [Phase 1]. Time        Frame: As per IWG Response Assessment Guidelines for AML and MDS        based on investigator's assessment through study completion.    -   9. Incidence and severity of adverse events, clinical laboratory        abnormalities, and changes in ECG parameters as assessed by        CTCAE v4.0 as a single-agent or in combination with azacitidine        [Phase 2]. Time Frame: Safety will be assessed from time of        first dose through 28 days post last dose.    -   10. Additional measures of antileukemic or antimyelodysplastic        activity as determined by CRh, Overall Response (OR), and Stable        Disease of Compound 1 alone or in combination with azacitidine        [Phase 2]. Time Frame: As per IWG Response Assessment Guidelines        for AML and MDS based on investigator's assessment through study        completion.    -   11. Time to Response (TTR) [Phase 2]. Time Frame: From first        dose of study drug through time of first response by blood        recovery count.    -   12. Duration of Response (DOR) [Phase 2]. Time Frame: From time        of first response by blood recovery count through relapse.    -   13. Event-Free Survival (EFS) [Phase 2]. Time Frame: From time        of entry on study through progression.    -   14. Overall Survival (OS) [Phase 2]. Time Frame: From time of        entry on study through death or date last known alive at end of        follow-up.        Disease History and Baseline Characteristics of Participants

A summary the disease history and participant demographics is providedbelow:

TABLE 16 Demographics and Disease History Compound Compound 1 + 1 AZACharacteristic (n = 32)* (n = 46) Age, median (range), years  72 (35-87) 67 (31-88) Female, % 50 52 ECOG PS - 0/1/2.% 28/50/22 28/57/15 AML, n26 39 Relapsed 14 11 >12 mo 4 1 ≤12 mo 10 10 Refractory 8 15Treatment-naïve 4 13 Prior regimens, median 2 (0-9) 3 (0-6) (range)**HMA (azacitidine/decitabine) 12 9 IDHm inhibitor 1 4 Investigational 2 2HSTC 2 3 MDS, n 6 7 Relapsed/Refractory 4 2 Treatment-naïve 2 5 Priorregimens, median (range) 1 (0-4) 0 (0-4) HMA (azacitidine/decitabine) 42 *Including 3 pts treated with 100 mg QD with food. **Not inclusive ofall types; pt could have received more than one type

A summary of the baseline disease characteristics is shown below:

TABLE 17 Baseline Disease Characteristics All AML + R/R AML TN AML MDS**MDS All SA and CO (n = 48) (n = 17) (n = 13) (n = 78) IDH1 mutationtype*, n R132C 23 10 5 38 R132H 13 3 6 22 R132S 6 2 0 8 R132G 5 2 1 8R132L 1 0 0 1 Concurrent mutations*, n FLT3 12 0 1 13 NPM1 12 1 1 14CEBPA 1 0 1 2 TP53 3 0 1 4 IDH2 1 1 0 2 *As reported by investigator perlocal tests **One pt with R100 mutation

A summary of the Investigator-Assessed Response is shown below:

TABLE 18 Investigator-Assessed Response Compound 1 SA Compound 1 + AZAR/R AML All Pts R/R AML All Pts* Response (n = 22) (n = 32) (n = 26) (n= 45) ORR, n (%)** 9 (41) 12 (38) 12 (46) 26 (58) [95% Cl] [21, 64] [21,56] [27, 67] [42, 72] CR/CRm, n (%) 4 (18)  5 (16)  3 (12) 14 (31) CRh,n (%) 3 (14) 3 (9) 1 (4) 1 (2) Cri, n (%) 2 (9)  3 (9)  6 (23)  9 (20)MLFS, n (%) 0 0 2 (8) 2 (4) Marrow CR, n N/A 1 (3) N/A 0 (%) SD, n (%) 5(23)  9 (28) 11 (42) 14 (31) PD, n (%) 2 (9)  3 (9) 1 (4) 1 (2) NE, n(%) 6 (27)  8 (25) 2 (8) 4 (9) *one pt excluded from efficacy analysisdue to the lack of a R132X mutation; pt continued on treatment andachieved a marrow CR **ORR = overall response rate (CR/CRm + CRh + Cri +MLFS + Marrow CR)

Exemplary AML patient disposition is summarized in Table 19.

TABLE 19 Compound 1 + Compound 1 AZA Characteristic (N = 32) (N = 46)Treatment ongoing, n (%) 3 (9) 10 (22) Discontinued from studytreatment, 29 (91) 36 (78) n (%) Transplant (HSCT)  4 (13) 10 (22)Disease progression 12 (38) 11 (24) Investigator decision 1 (3)  5 (11)Permanent withdrawal of consent 1 (3) 0 Death  5 (16) 4 (9) Adverseevent 3 (9) 3 (7) Other^(a) 3 (9) 3 (7) Median time on treatment, months4.2 4.7 ^(a)Other reasons include lack of response (for monotherapy andcombination therapy groups); entering hospice, and alternativetreatments (for combination therapy group)

Non-hematologic and hematologic TEAEs are summarized in Table 20 andTable 21 below. No DLTs were observed in dose escalation cohorts. IDHdifferentiation syndrome (IDH-DS) adverse events were experienced by 4monotherapy patients (13%; grade 3,3; grade 2,1) and 6 combinationtherapy patients (13%; grade 3,3; grade 2,1). Most (7) were observedduring cycle 1 (2 in cycle 2, 1 in cycle 5). All cases resolved withtreatment interruption/reduction, dexamethasone, and/or supportivetreatment. No recurrences were observed. Of the patients who experienceda IDH-DS AE, 2 of 4 monotherapy patients and 5 of 6 combination therapypatients achieved a response. QT prolongation was reported in 3combination therapy patients (7%); all events were transient, andpatients resumed treatment with no recurrences. Five of 32 patients inmonotherapy and 5 of 46 patients in combination therapy had grade ≥3 LFT(ALT, AST, TB) abnormalities, and two patients (1 monotherapy, 1combination therapy) discontinued treatment due to these events.

TABLE 20 Compound 1 Compound 1 + AZA (N = 32) (N = 46) TEAE, n (%) AnyGrade Grade 3-4 Any Grade Grade 3-4 Nausea 15 (47)  0 32 (70) 4 (9)Fatigue 14 (44)  2 (6) 18 (39)  8 (17) Pyrexia 11 (34)  2 (6) 11 (24) 0Diarrhea 8 (25) 1 (3) 21 (46) 2 (4) Pneumonia 8 (25)  5 (16)  8 (17)  5(11) Vomiting 8 (25) 0 17 (37) 1 (2) Constipation 7 (22) 1 (3) 27 (59) 1(2) Decreased appetite 7 (22) 0 11 (24) 1 (2) Dizziness 7 (22) 1 (3) 11(24) 1 (2) Dyspnea 7 (22) 0 14 (30) 1 (2) Hypokalemia 7 (22) 2 (6) 16(35) 3 (7) Headache 6 (19) 0 15 (33) 1 (2) Cough 5 (16) 0 18 (39) 1 (2)Hypertension 4 (13) 3 (9) 10 (22)  8 (17) Peripheral Edema 2 (6)  0 10(22) 0 Abdominal pain 1 (3)  0 10 (22) 1 (2) Asthenia 1 (3)  0 11 (24) 2(4)

TABLE 21 Compound 1 Compound 1 + AZA (N = 32) (N = 46) TEAE, n (%) AnyGrade Grade 3-4 Any Grade Grade 3-4 Thrombocytopenia 9 (28) 9 (28) 21(46) 19 (41) Neutropenia 3 (9)  2 (6)  14 (30) 13 (28) Leukocytosis 7(22) 4 (13) 12 (26)  7 (15) Anemia 7 (22) 7 (22) 11 (24)  9 (20) Febrileneutropenia 7 (22) 7 (22) 15 (33) 13 (28)

Clinical response of patients with AML is summarized in FIG. 9.

Survival of patients with AML is summarized in FIG. 10.

97% of patients had ≥1 co-mutation, and 39% of patients had ≥3co-mutations (FIG. 11).

Exemplary MDS patient disposition is summarized in Table 22. Median timeon treatment for all patients with MDS treated with olutasidenib (±AZA)was 8.0 months.

TABLE 22 Compound 1 Compound 1 + AZA Characteristic (N = 6) (N = 17)Treatment ongoing, n (%) 2 (33) 10 (59) Treatment discontinued, n (%) 4(67)  7 (41) Transplant 0  3 (18) Disease progression 3 (5)  1 (6) Death0 1 (6) Adverse event 1 (17) 0 Other 0  2 (12) Time on treatment,median,   6.3 15  months

A summary of clinical activity in MDS patients is summarized in Table23.

TABLE 23 Investigator-Assessed Compound 1 Compound 1 + AZA Response, n(%) (N = 6) (N = 16)^(a) ORR^(b) 3 (50) 9 (56) [95% Cl] [11.8-88.2][29.9-80.2] CR 2 (33) 4 (25) Marrow CR 1 (17) 5 (31) Clinical benefit 1(17) 5 (31) (CB = SD ≥ 8 weeks) PD 1 (17) 1 (6)  NE 1 (17) 1 (6)  Timeto first response,   8.3 (<1-9.7)   2.8 (<1-5.1) median (range), monthsDuration of overall response,   NR (6.7-NR)  12.9 (<1-NR) median(range), months ^(a)Efficacy evaluable population. One patient wasexcluded from efficacy analysis due to lack of R132X mutation. ^(b)ORR =CR + marrow CR + PR. NR, not reached.

FIG. 12 summarizes time on treatment for patients with MDS.

Table 24 summarizes hematologic improvement in clinical benefit andmarrow CR for MDS patients.

TABLE 24 Compound 1 + Compound 1 AZA Response, n (%) (N = 6) (N =16)^(a) Patients with CB or Marrow CR 2 (33)  10 (63)  Patients withhematologic improvement 2 (100) 9 (90) Erythroid improvement BLhemoglobin < 11 g/dL 2 (100) 9 (90) Hemoglobin increase by ≥1.5 g/dLfrom BL 2 (100) 4 (44) Platelet improvement BL platelet < 100 × 10⁹/L 2(100) 7 (70) Any improvement 1 (50)  2 (29) Change > 30 × 10⁹/L (BL ≥ 20× 10⁹/L) 1 (50)  1 (14) At least 100% increase to >20 × 10⁹/L (BL < 20 ×0 1 (14) 10⁹/L) Neutrophil improvement BL neutrophils < 1 × 10⁹/L 1(50)  8 (80) Increase > 0.5 × 10⁹/L and ≥ 100% increase from BL 1 (100) 8 (100) ^(a)Efficacy evaluable population. One patient was excludedfrom efficacy analysis due to lack of R132X mutation.

TEAEs (≥20% overall) in MDS patients are summarized in Table 25.IDH-differentiation syndrome was observed in 3 (13%) of patients. LFT(AST, AST, bilirubin) abnormalities were observed in 4 pts; 2 (G1, G3)continued dosing through the elevation, 1 (G3) improved with dosereduction, and 1 (G3) discontinued treatment after a positivere-challenge.

TABLE 25 Compound 1 Compound 1 + AZA (N = 6) (N = 17) Overall TEAE, n(%) Any Grade Grade 3/4 Any Grade Grade 3/4 Any Grade HematologicThrombocytopenia 2 (33) 2 (33) 7 (41)  4 (24) 9 (39) Neutropenia 1 (17)1 (17) 6 (35)  6 (35) 7 (30) Nonhematologic Nausea 4 (67) 0 9 (53) 1 (6)13 (57)  Fatigue 4 (67) 1 (17) 6 (35)  2 (12) 10 (43)  Arthralgia 4 (67)1 (17) 5 (29) 0 9 (39) Constipation 1 (17) 0 8 (47) 0 9 (39) Dyspnoea 2(33) 0 5 (29) 1 (6) 7 (30) Vomiting 2 (33) 0 5 (29) 0 7 (30) Cough 1(17) 0 5 (29) 0 6 (26) Dizziness 1 (17) 0 5 (29) 0 6 (26) Headache 2(33) 0 4 (24) 0 6 (26) Diarrhea 1 (17) 0 4 (24) 1 (6) 5 (22) Hematuria 2(33) 0 3 (18) 1 (6) 5 (22) Pain in extremity 3 (50) 0 2 (12) 1 (6) 5(22)

Twenty-two mutations were identified in 17 patients with samplesavailable for central analysis (see FIG. 13). Three patients hadmultiple baseline IDH1 mutations.

Dosing

The present disclosure includes, among other things, the novelunderstanding that administration of 300 mg of Compound 1 (e.g., 150 mgBID or 300 mg QD) to a patient or population of patients results in asustained therapeutically effective trough blood plasma concentration(Css). Such a Css of Compound 1 resulted in a durable reduction in 2-HGplasma level over the course of at least 6 treatment cycles.

As outlined in Example 11, the concentration total plasma concentrationof Compound 1 and the plasma concentration of 2-HG was measured in theblood of patients receiving one of three different dose and doseintervals: 150 mg QD, 300 mg QD or 150 mg BID (either receiving Compound1 as a single agent or in combination with azacitidine as described inthe clinical trial of Example 11, in each category). The 2-HG levelswere measured prior to administration of Compound 1, and then measuredafter administration of Compound 1 up to cycle 2, day 1 after firstreceiving Compound 1 (as the solid form obtained from Example 5).

As shown in FIG. 14 and FIG. 15, the administration of Compound 1 at 150mg BID resulted in a trough blood plasma concentration above 1,652 ng/mLafter cycle 2 of a 28-day treatment cycle as both a single agent and incombination with azacitidine. Additionally, as shown in FIG. 16 and FIG.17, a reduction of 2-HG level was observed. The decrease in 2-HGconcentration observed in patients receiving Compound 1 at 150 mg BID or300 mg QD is unexpectedly better than those who received Compound 1 at150 mg QD, both in terms of magnitude and variability of effect.

As shown in FIG. 18A-18E, the plasma exposures (steady state bloodplasma concentration) of Compound 1 were durable (i.e., sustained)throughout at least a 6 cycle treatment duration. As shown in FIGS.19A-19D the plasma 2-HG concentrations were reduced within 1 cycle(C2D1) and maintained throughout the treatment duration.

Variant Allele Frequency (VAF) Analysis—AML

229 samples (213 from white blood cells (PaxGene and EDTA) and 16 frombone marrow analysis) were obtained from 59 AML patients treated witheither Compound 1 as a single agent or Compound 1 in combination withazacitidine in the Phase 1 study. Next generation sequencing was carriedout through target enrichment using HaloPlex® Target followed byIllumina® sequencing; coverage >100× across 75 genes. Digitial dropletPCR (ddPCR) was carried out through an input of 20 ng on a Stilla3-channel system; VAF data based on >20,000 droplets.

As shown in FIG. 25, good correlation between ddPCR and NGS wasobserved, which justifies using ddPCR for on-treatment assessment ofIDH1 VAF. As shown in FIG. 26, detection of IDH1 from BMA can be usefulin patients with low IDH1 VAF in WB.

Of the 59 pts with local and central IDH1m results (all sample typesincluded), 53/59 (90%) central testing confirmed presence of IDH1m atstudy entry.

As shown in FIG. 27A, FIG. 27B, FIG. 28, and FIG. 29, upon treatmentwith Compound 1, significant reduction in IDH1 VAF across categories wasobserved. 25 patients achieved an objective response and 6 patients withSD had available longitudinal samples for analysis (VAF at ≥C3). IDH1mutation clearance/significant reduction is observed in 10/25 (40%)patients with an IWG response to Compound 1 (FIG. 27A). In patients withstable disease, 3/6 (50%) had clearance/significant reduction of theIDH1m VAF (FIG. 27B). FIGS. 28 and 29 show that clinical response isassociated with a decrease in 2-HG and clearance of the IDH1m clone.

VAF Analysis—MDS

As shown in FIG. 30, treatment with Compound 1 induces IDH1 mutationclearance and reduces 2-HG levels. 44% of patients (4/9) experiencedmutation clearance (VAF <1%; only patients who received ≥3 cycles oftreatment and ≥1 post-baseline VAF assessment were analyzed for mutationclearance). Rapid reduction of 2-HG was observed by end of cycle 1.

Mechanism Resistance/Escape

The following details two case studies of individual patients.

Case Study 1: IDH2-Mediated Resistance

As shown in FIG. 31, an R/R AML patient with known IDH2m at baseline wastreated with Compound 1 in combination with azacitidine. The patientremained in stable disease for 6 cycles then progressed. Compound 1induced clearance of the IDH1m clone, however azacitidine was noteffective in controlling the IDH2m clone that eventually drove theclinical progression.

Case Study 2: Presence of Additional Non-IDH1m Clones Drive Resistance

A treat naïve AML secondary to MDS patient treated with Compound 1 as asingle agent. As shown in FIG. 32, this patient remained stable for 15cycles with no achievement of an IWG response, however IDH1 mutationclearance and normalization of 2-HG were observed.

Conclusion

Compound 1 demonstrates clinical activity as a single agent and incombination with azacitidine in a high-risk Phase 1 population ofAML/MDS patients with IDH1 mutation. In R/R AML, 41% and 46% pts achieveORR with Compound 1 as a single agent and Compound 1 in combination withazacitidine treatment, respectively. 90% of pts enrolled with a historyof IDH1m determined locally had a IDH1m confirmed centrally. Baselineco-mutation analyses demonstrated no correlation with clinical response(likely due to the small number of patients). Compound 1 induces IDH1mutation clearance or significant reduction in treatment naïve and R/RAML patients regardless of IWG response. Of the 25 patient that achievedan objective response and with available samples (VAF at ≥C3), 10 (40%)had clearance or significant VAF reduction to <1%. Six stable diseasepatients had samples available and three (50%) had clearance orsignificant VAF reduction. Initial analysis of patients whorelapse/progress on Compound 1 suggests non-IDHm-driven mechanism ofescape.

Compound 1 is well-tolerated as a single agent and in combination withAZA in patients with MDS. Patients with MDS remained on treatment for amedian of 8 months. Compound 1 demonstrated preliminary clinicalactivity as a single agent and in combination with AZA in treatmentnaïve and relapsed/refractory patients with MDS. 50% (3/6) patientstreated with Compound 1 monotherapy achieved CR/mCR; 56% (9/16) patientstreated with Compound 1+AZA achieved CR/mCR. Clinical benefit withhematologic improvement was observed with Compound 1 monotherapy andcombination therapy in 17% and 31% of patients, respectively. Mutationclearance was observed in 44% of evaluable patients. Rapid and sustainedreduction of 2-HG was seen by the end of cycle 1.

Example 12: A Phase 1b/2 Study of Compound 1 in Patients with AdvancedCNS and Solid Tumors with an IDH1 Mutation

Patients having any of the following solid tumors that harbor a IDH1mutation received Compound 1 (unless otherwise indicated, at a dose of150 mg of the solid form provided in Example 5, administered orally BID)as a single agent or in combination with additional therapies:

-   -   Compound 1 was administered to patients diagnosed with glioma or        chondrosarcoma as a single agent or in combination with        5-azacitidine (also referred to herein as “5-azacytidine” or        “azacytidine” or “azacitidine”);    -   Compound 1 was administered to patients diagnosed with        hepatobiliary cancers as a single agent or in combination with a        PD-1 inhibitor (preferably, nivolumab);    -   Compound 1 was administered to patients diagnosed with        intrahepatic cholangiocarcinoma as a single agent or in        combination with gemcitabine and cisplatin (“GemCis”); and    -   Compound 1 was administered to patients diagnosed with other        non-CNS solid tumors as a single agent.

Each patient had a histologically or cytologically-confirmed IDH1 R132Xgene-mutated advanced solid tumor prior to receiving Compound 1. Inparticular, some patients receiving Compound 1 had a histologically orcytologically-confirmed IDH1 R132X gene-mutated advanced glioma that hasrecurred or progressed following standard therapy. Patients receivingCompound 1 can have relapsed or refractory glioma (per WHO criteria2016) with confirmed IDH1 mutation. Other patients receiving Compound 1had relapsed or refractory hepatobiliary tumors with confirmed IDH1mutation previously treated with an approved therapy for HBC. Otherpatients receiving Compound 1 had recurrent, refractory or eitherlocally advanced or metastatic chondrosarcoma with confirmed IDH1mutation not amenable to complete surgical excision. Other patientsreceiving Compound 1 had advanced, nonresectable or metastaticintrahepatic cholangiocarcinoma with confirmed IDH1 mutation noteligible for curative resection or transplantation. Some patientsreceiving Compound 1 had relapsed or refractory other solid tumors withconfirmed IDH1 mutation.

Patients were assessed for pharmacokinetics (PK) (e.g., by collecting ablood sample) at regular intervals throughout a course of treatment. Inparticular, pre-dose PK assessment was performed at least on days 1, 2,8, 15, and 22 of the course of treatment for patients having a course oftreatment comprising one or more 28-day treatment cycles. (Additionalpost dose assessment can be performed at cycle 1 day 1 and cycle 2 day1.) In addition, pre-dose PK assessments were collected on day 1, 2 and15 of cycle 2 of a 28-day treatment cycle during the course oftreatment. Additional pre-dose PK assessment was performed on day 1 ofCycle 3 and subsequent 28-day treatment cycles during the course oftreatment.

Compound 1 was administered to patients who met the following criteriafor inclusion: ≥18 years of age; Life expectancy of ≥4 months;Documented IDH1 gene-mutated malignancy based on local test evaluation;Able to provide tumor tissue sample (archival); and cancer diagnosis asdescribed above. Preferably, patients also met one or more of thefollowing additional inclusion criteria:

-   -   Recovered to ≤Grade 2 or baseline toxicity (except alopecia)        from prior therapy (per CTCAE v 4.03);    -   Eastern Cooperative Oncology Group (ECOG) performance status        0-2;    -   Adequate bone marrow function (e.g., Absolute neutrophil count        (ANC) ≥1.5×109/L without any growth factors in prior 7 days and        Hemoglobin ≥8.0 g/dL (with or without transfusion support);        Platelet count ≥75×10⁹/L (with or without transfusion support);        Cohort 4b (GemCis combination); and platelet count ≥100×109/L        (with or without transfusion support));    -   Child-Pugh Class A (HBC only);    -   Adequate hepatic function (e.g, Aspartate aminotransferase (AST)        (serum glutamic oxaloacetic transaminase [SGOT])/alanine        aminotransferase (ALT) (serum glutamic pyruvate transaminase        [SGPT])≤2.5× institutional upper limit of normal (ULN). For        patients with suspected malignancy related elevations, <5×ULN;        and Total bilirubin ≤1.5×ULN. For patients with suspected        malignancy related elevation <3× institutional upper limit of        normal); and    -   Adequate renal function (e.g, Creatinine clearance per        Cockcroft-Gault equation of ≥60 mL/min).

Compound 1 was not administered to patients who met one or more of thefollowing exclusion criteria:

-   -   Previous solid organ or hematopoietic cell transplant    -   Prior anticancer treatment (e.g, No prior treatment with small        molecule, antibody, or other anticancer therapeutic within 21        days (or 5 half-lives), whichever is shorter of first dose of        study treatment (6 weeks for nitrosoureas or mitomycin C); No        previous treatment with an IDH1 inhibitor; No prior radiation        therapy (including radiofrequency ablation) within 4 weeks prior        to initiation of study treatment; No prior stereotactic body        radiation therapy (SBRT) within 2 weeks prior to initiation of        study treatment; and No prior chemoembolization or        radioembolization within 4 weeks)    -   Congestive heart failure (New York Heart Association Class III        or IV) or unstable angina pectoris; previous history of        myocardial infarction within one year prior to study entry,        uncontrolled hypertension, or uncontrolled arrhythmias    -   History of QT prolongation or baseline QT interval corrected        with Fridericia's method (QTcF) >450 ms (average of triplicate        readings) (NOTE: criterion does not apply to patients with a        right or left bundle branch block)    -   Concomitant medication(s) associated with QTc interval        prolongation or Torsades de Pointes (TdP) initiated less than        the duration required to reach steady-state plasma concentration        (approximately five half-lives) before first dose of study drug        (medications used as needed [PRN] (e.g. Zofran) are exempt).    -   Pregnant or nursing women or women of childbearing potential not        using adequate contraception; male patients not using adequate        contraception    -   Other malignancy within the last 5 years except: adequately        treated non-melanoma skin cancer, curatively treated in situ        cancer of the cervix, ductal carcinoma in situ (DCIS), stage 1,        grade 1 endometrial carcinoma, or other solid tumors including        lymphomas (without bone marrow involvement) curatively treated        with no evidence of disease for ≥5 years    -   Major surgery within 4 weeks of starting study treatment or not        recovered from any effects of prior major surgery (uncomplicated        central line placement or fine needle aspirate are not        considered major surgery);    -   Patients receiving >6 mg/day of dexamethasone or equivalent    -   Patients with gastrointestinal disorders likely to interfere        with absorption of the study medication    -   Known history of HIV positivity    -   Active infection with hepatitis B or C virus (Hep B or C viral        load>100 international units/milliliter or local institutional        equivalent)    -   Unstable or severe uncontrolled medical condition (e.g.,        unstable cardiac function, unstable pulmonary condition        including pneumonitis and/or interstitial lung disease,        uncontrolled diabetes) or any important medical or psychiatric        illness or abnormal laboratory finding that would, in the        Investigator's judgment, increase the risk to the patient        associated with his or her participation in the study and    -   PD-1 combination only: Patients with active autoimmune disease        (Note: patients with well controlled diabetes or hypothyroidism        are eligible).

Each patient received Compound 1 throughout a medically appropriatecourse of treatment. In general, patients received Compound 1 (eithersingle-agent Compound 1 or combination therapy as indicated above) untildisease progression or unacceptable toxicity. At the start of the courseof treatment, each patient received Compound 1 as the solid formobtainable by the method of Example 5 at a dose of 150 mg BIDadministered continuously in one or more 28-day treatment cycles.

The DLT-Evaluable Analysis Set was defined as all patients in the SafetyLead-in Periods (single agent Compound 1, combination Compound1+5-azacitidine, combination Compound 1+GemCis and combination Compound1+PD-1 inhibitor such as nivolumab) who either experienced a DLT duringCycle 1 or completed at least 75% of the prescribed Cycle 1 dose. Theseanalysis sets were used to assess the tolerability of Compound 1.

The Safety Analysis Set was defined as all patients who received anyamount of study drug(s) (Compound 1 and combination agents, ifappropriate). This analysis set was the primary analysis set for allsafety endpoints, excluding DLT evaluation. Safety analysis was bycohort and by treatment within cohort if more than one dose or dosingcombination were initiated for a particular indication cohort.

The Response-Evaluable Analysis Set was defined as all patients withmeasurable disease at baseline who received the study drug(s) specificto the part of their particular cohort (either Compound 1 monotherapy orCompound 1 in combination), and had at least 1 post-baseline responseassessment or discontinued the treatment phase due to diseaseprogression (including death caused by disease progression) within 8weeks (+2-week window) of the first dose of study treatment. Thisanalysis set was the primary analysis set for efficacy endpoints such asORR. All response evaluations were by cohort, and by treatment withincohort if more than 1 doses or dosing combinations are initiated for aparticular indication cohort.

Patient safety measurements and clinical laboratory measurements wereperformed throughout the course of treatment for each cohort. Safetymeasurements included assessment of patient concomitant medications andprocedures, AE/SAE assessment, symptom-directed physical examination andECOG performance status. Clinical laboratory measurement assessmentincluded blood chemistry and hematology and other measurements specificto individual cohorts.

For patients receiving Compound 1 as a single agent, or in combinationwith 5-azacitidine (glioma, chondrosarcoma) or in combination with aPD-1 inhibitor (HBC), Compound 1 was administered in a 28-day treatmentcycle (28 consecutive days, at a dose of 150 mg BID) and patient safetymeasurement and clinical blood chemistry and hematology were obtained onthe following days during the course of treatment for patients in thefirst 28-day treatment cycle during the clinical trial: day 1, day 8(+/−2), day 15 (+/−2), day 22 (+/−2). In treatment cycle 2 and beyond,these assessments were obtained at day 1 (+/−2) and day 15 (+/−2).

For patients receiving Compound 1 in combination with chemotherapy(e.g., GemCis for cholangiocarcinoma), Compound 1 was administered in a28-day treatment cycle (28 consecutive days, at a dose of 150 mg BID)and patient safety measurement and clinical blood chemistry andhematology were obtained on the following days during the course oftreatment for patients in the first six 28-day treatment cycle duringthe clinical trial: day 1, day 8 (+/−2), day 15 (+/−2), day 22 (+/−2).The combination was given for a total of six treatment cycles. Intreatment cycle 7 and beyond, these assessments are obtained at day 1(+/−2) and day 15 (+/−2). The patient could continue on single agentCompound 1 treatment without combination agent as directed by treatingphysician.

Safety Lead-In Period

The study included a Safety Lead-in Period where single-agent 150 mgCompound 1 BID was administered over 28 days (1 cycle). TheSafety-Lead-in Period employed a traditional 3+3 design, whereby 3patients with solid tumors and 3 patients with gliomas were treated withCompound 1 150 mg BID and monitored for dose-limiting toxicities (DLTs)during the first cycle of study treatment.

-   -   If no DLTs occur in the first 3 patients in either group (solid        tumors or glioma), and available pharmacokinetic        (PK)/pharmacodynamic (PD) data support the dose, enrollment        continues in the 4 disease-specific cohorts described below.    -   If a DLT occurs in the first 3 patients in either group, an        additional 3 patients are treated at that dose level in the        relevant group. If no DLTs occur in these additional 3 patients        (i.e. <2 DLTs per 6 patients) and available PK/PD data support        the dose, enrollment continues in the 4 disease-specific cohorts        described below.    -   If there are ≥2 DLTs at the starting dose, lower doses or an        altered dosing schedule of Compound 1 can be considered.        Likewise, higher doses may be evaluated based upon safety, PK,        and PD data as determined by the SRC.        Cohort 1: Glioma (n=16-31)

Compound 1 is used to treat patients diagnosed with a glioma cancerdiagnosis. In particular, Compound 1 is administered to patients meetingthe inclusion criteria above and one or more the following diseaserelated inclusion criteria: histologically or cytologically confirmedIDH1 gene-mutated advanced glioma, and a diagnosis of glioblastomamultiforme with confirmed IDH1 gene-mutated disease with first or secondrecurrence. Cohort 1 includes patients with glioma harboring an IDH1mutation that is relapsed or refractory. Glioma patients are treatedwith single-agent Compound 1 (Cohort 1a). Cohort 1a employs a Simon's2-stage design, in which 8 patients are treated with single-agentCompound 1 for a minimum of 4 cycles (cycle=28 days) and assessed forefficacy and safety (Stage 1). If ≥1 clinical response is observed inStage 1, then Stage 2 (n=15) initiates with single-agent Compound 1. Ifno clinical responses are observed in Stage 1 with single-agent Compound1, then combination therapy is examined (Compound 1+5-azacytidine)(Cohort 1b). Cohort 1b employs a Simon's 2-stage design, whereby 8patients are treated in Stage 1 with combination therapy for a minimumof 4 cycles (cycle=28 days) and assessed for efficacy and safety. If ≥1clinical response is observed in Stage 1 of Cohort 1b, then Stage 2(n=15) is initiated with combination therapy. During Stage 1 aggregatesafety data are monitored by the SRC. If unacceptable toxicity isobserved in Stage 1, then the dose and schedule may be modified by theSRC. (Note: any glioma patients enrolled in the safety Lead-in Periodare considered part of Stage 1 enrollment.)

Cohort 2. Hepatobiliary Carcinoma (HBC) (n=21-63)

Compound 1 is used to treat patients diagnosed with a hepatobiliarycarcinoma (HBC) cancer diagnosis. In particular, Compound 1 isadministered to patients meeting the inclusion criteria above and one ormore the following disease related inclusion criteria:Relapsed/refractory or intolerant to approved standard-of-care therapy(included: hepatocellular carcinoma, biliary carcinoma or otherhepatobiliary carcinomas); Histologically or cytologically confirmedIDH1 gene-mutated with measurable disease per RECIST 1.1 criteria; andChild-Pugh Class A.

Cohort 2 includes patients with relapsed/refractory HBC harboring anIDH1 mutation. HBC patients are initially treated with single-agentCompound 1 (Cohort 2a). Prior exposure to nivolumab is permitted forpatients of Cohort 2a. Cohort 2a employs a Simon's 2-stage design, inwhich 8 patients are treated with single-agent Compound 1 for a minimumof 4 cycles (cycle=28 days) and assessed for efficacy and safety (Stage1). If ≥1 clinical response is observed in Stage 1, then Stage 2 (n=15)is initiated with single-agent Compound 1. If no clinical responses areobserved in Stage 1 with single-agent Compound 1, then combinationtherapy can be examined (Compound 1+PD1 inhibitor) (Cohort 2b). Cohort2b employs a Simon's 2-stage design, whereby 13 patients are treated inStage 1 with combination therapy for a minimum of 4 cycles (cycle=28days) and assessed for efficacy and safety. If ≥4 clinical response isobserved in Stage 1 of Cohort 2b, then Stage 2 (n=42) can initiate withcombination therapy. Prior exposure to nivolumab is not permitted forpatients of Cohort 2b. During Stage 1 aggregate safety data is monitoredby the SRC. If unacceptable toxicity is observed in Stage 1, then thedose and schedule may be modified by the SRC. (Note: any HBC patientsenrolled in the Safety Lead-in Period are considered part of Stage 1enrollment.)

Cohort 3: Chondrosarcoma (n 16-31)

Compound 1 is used to treat patients diagnosed with a chondrosarcomacancer diagnosis. In particular, Compound 1 is administered to patientsmeeting the inclusion criteria above and one or more the followingdisease related inclusion criteria: Relapsed or refractory and eitherlocally advanced or metastatic and not amenable to complete surgicalexcision; and histologically or cytologically confirmed IDH1gene-mutated with measurable disease per RECIST 1.1 criteria. Cohort 3includes patients with relapsed/refractory, locally advanced ormetastatic chondrosarcoma harboring an IDH1 mutation. Chondrosarcomapatients are treated with single-agent Compound 1 (Cohort 3a). Cohort 3awill employ a Simon's 2-stage design, in which 8 patients will betreated with single-agent Compound 1 for a minimum of 4 cycles (cycle=28days) and assessed for efficacy and safety (Stage 1). If ≥1 clinicalresponse is observed in Stage 1, then Stage 2 (n=15) will initiate withsingle-agent Compound 1. If no clinical responses are observed in Stage1 with single-agent Compound 1, then combination therapy is examined(Compound 1+5-azacytidine) (Cohort 3b). Cohort 3b employs a Simon's2-stage design, whereby 8 patients are treated in Stage 1 withcombination therapy for a minimum of 4 cycles (cycle=28 days) andassessed for efficacy and safety. If ≥1 clinical response is observed inStage 1 of Cohort 3b, then Stage 2 (n=15) initiates with combinationtherapy. During Stage 1 aggregate safety data are monitored by the SRC.If unacceptable toxicity is observed in Stage 1, then the dose andschedule may be modified by the SRC. (Note: any chondrosarcoma patientsenrolled in the Safety Lead-in Period are considered part of Stage 1enrollment.)

Cohort 4: Intrahepatic Cholangiocarcinoma (n=21-63)

Compound 1 is used to treat patients diagnosed with an intrahepaticcholangiocarcinoma (IHCC) cancer diagnosis. In particular, Compound 1 isadministered to patients meeting the inclusion criteria above and one ormore of the following disease related inclusion criteria: Advancednonresectable or metastatic IHCC not eligible for curative resection ortransplantation; Phase 1b/Safety Lead-in of Phase 2: relapsed orrefractory disease; and histologically or cytologically confirmed IDH1gene-mutated with measurable disease per RECIST 1.1 criteria. Cohort 4includes patients with advanced IHCC harboring an IDH1 mutation. IHCCpatients are treated with single-agent Compound 1 (Cohort 4a). Patientsof cohort 4a must be ineligible for standard therapies. Cohort 4aemploys a Simon's 2-stage design, in which 8 patients are treated withsingle-agent Compound 1 for a minimum of 4 cycles (cycle=28 days) andassessed for efficacy and safety (Stage 1). If ≥2 clinical responses areobserved in Stage 1, then Stage 2 (n=15) initiates with single-agentCompound 1. If <2 clinical responses are observed in Stage 1 withsingle-agent Compound 1, then combination therapy is examined (Compound1+GemCis) (Cohort 4b). Patients in Cohort 4b have received no more thanone cycle of Gem/Cis therapy. Cohort 4b employs a Simon's 2-stagedesign, whereby 13 patients are treated in Stage 1 with combinationtherapy for a minimum of 4 cycles (cycle=21 days) and assessed forefficacy and safety. If ≥4 clinical responses are observed in Stage 1 ofCohort 4b, then Stage 2 (n=42) initiates with combination therapy.During Stage 1 aggregate safety data are monitored by the SRC. Ifunacceptable toxicity is observed in Stage 1, then the dose and schedulemay be modified by the SRC. (Note: any IHCC patients enrolled in theSafety Lead-in Period are considered part of Stage 1 enrollment.)

In some examples, patients diagnosed with relapsed/refractory IHCCreceive Compound 1 single agent, whereas patients newly diagnosed andtreatment naïve IHCC receive Compound 1 in combination with GemCischemotherapy.

Cohort 5: Other Non-CNS Solid Tumors with IDH1 Mutations (n=12)

Compound 1 is used to treat patients diagnosed with non-CNS solid tumorswith IDH1 mutations (preferably detectable 2-HG in plasma). Cohort 5includes patients with relapsed or refractory non-CNS solid tumorsharboring an IDH1 mutation. In particular, Compound 1 is administered topatients meeting the inclusion criteria above and one or more of thefollowing disease related inclusion criteria: relapsed or refractory tostandard-of-care therapy with no other available therapeutic options;and histologically or cytologically confirmed IDH1 gene-mutated withmeasurable disease per disease appropriate response criteria. Thiscohort includes treatment with single agent Compound 1. Due to thediverse population, this is an exploratory cohort without pre-definedefficacy/futility determinations. Aggregate safety data is monitored bythe SRC and if unacceptable toxicity is observed in ≥2 patients, thecohort can be closed for additional enrollment.

For Cohorts 1-5 above, the efficacy assessments obtained include thoselisted in the table below. (MRS=1H magnetic resonance spectroscopy;MRI=magnetic resonance imaging).

TABLE 26 Assessment Response Cohort Population Criteria AssessmentBiomarkers Cycles (day 1) 1 Glioma Modified Contrast- N/A C3, C5, C7,C9, RANO Criteria enhanced MRI C12, 2017, Low and MRS for 2- every 3cycles Grade Glioma HG (central) thereafter RANO 2011 2 HBC ModifiedCT/MRI Serum AFP, C3, C5, C7, C9, RECIST CA19-9, C12, RECIST v1.1 andCEA every 3 cycles thereafter 3 Chondrosarcoma RECIST v 1.1 CT/18FDG-N/A C3, C5, C7, C9, PET C12, every 3 cycles thereafter 4Cholangiocarcinoma RECIST v1.1 CT/MRI Serum CA19- C3, C5, C7, C9, (IHCC)9, C12, and CEA every 3 cycles thereafter 5 Other Disease CT/MRI N/A C3,C5, C7, C9, IDH1 Solid appropriate C12, Tumors every 3 cycles thereafterResults—Glioma

Isocitrate dehydrogenase 1 mutations (mIDH1) are present in >70% ofpatients with Grade II/III gliomas resulting in production andaccumulation of (R)-2-hydroxyglutarate causing DNA hypermethylation andpromoting tumorigenesis. Patients (pts) with relapsed/refractory (R/R)mIDH1 gliomas received Compound 1 150 mg BID, orally either as singleagent (SA) or in combination (CO) with azacitidine in a doseconfirmation Phase 1b followed by efficacy evaluation Phase 2 study(NCT: 03684811).

As of 12 Sep. 2019, 24 pts with glioma (grade at enrollment: II/III/IV;n=4, n=12, and n=8, respectively) were treated with Compound 1monotherapy. The median age was 46 years (range: 23-64); 63% were menand 38% were women. Patients had a median of 2 prior treatments, and 88%had received prior temozolomide. IDH1 mutation status was locallydetermined (IHC, NGS, or PCR). Baseline patient characteristics aresummarized below. Values are presented as n (%) except for age and priorregimens.

TABLE 27 Compound 1 Characteristic N = 24 Age, Median (range), Years   46 (23-64) Female  9 (38) ECOG PS 0/1 21 (88) 2  3 (13) HistologyDiffuse Astrocytoma 1 (4) Oligodendroglioma 2 (8) Anaplastic Astrocytoma11 (46) Anaplastic Oligodendroglioma 2 (8) Glioblastoma  8 (33)Enhancing/Non-Enhancing 22/2 Prior Regimens, Median (range)  2 (1-5)Prior TMZ 21 (88) IDH1 Mutation R132H 21 (88) R132L 2 (8) R132C 1 (4)

Treatment-emergent adverse events (TEAEs) are summarized below. No DLTswere observed in dose-confirmation Phase 1b study with single agentCompound 1. Transaminase elevations resolved without sequelae in allpatients. No QTc prolongation was reported as an adverse event. Twelvepatients discontinued—11 for disease progression and 1 for grade 4 acutehepatitis.

TABLE 28 Compound 1 (N = 24) Preferred Term, n (%) All Grades Grade ≥ 3Any TEAE 24 (100) 11 (46)  Fatigue 12 (50)  0 Nausea 10 (42)  0 Diarrhea8 (33) 0 ALT Increased 7 (29)  3 (13)^(a) Headache 7 (29) 0 Constipation5 (21) 0 AST Increased 4 (17) 2 (8)^(a) Dizziness 4 (17) 0 Dysgeusia 4(17) 0 Fall 4 (17) 0 Platelet Count Decreased 4 (17) 1 (4)^(a) Seizure 4(17) 0 Hemiparesis 3 (13) 2 (8)^(a) Hypertension 3 (13) 0 Paraesthesia 3(13) 0 Upper Respiratory Tract 3 (13) 0 Infection Vomiting 3 (13) 1(4)^(a) ^(a)All Grade 3.

Duration of Compound 1 monotherapy treatment in predominantly enhancinggliomas is shown in FIG. 33. Median duration of treatment at time ofdata cut was 3.7 months (range: 0.9-9.4).

Best percent change in tumor burden with Compound 1 monotherapy perinvestigator assessment (RANO) is shown in FIG. 34.

Percent change in tumor burden with Compound 1 monotherapy per centralvolumetric assessment (BCIR) is shown in FIG. 35.

Best overall response for patients treated with Compound 1 monotherapyis summarized in Table 29.

TABLE 29 Best Overall Response N = 23^(a), n (%) CR/PR 1 (4) SD 10 (43)PD 12 (52) ^(a)One enrolled patient did not have measurable disease andwas not included in efficacy analysis.

FIG. 36 summarizes local biomarker testing and best clinical response.Most tumors had >1 co-mutation as determined from tumor biopsy. 11/24patients had no mutation testing done.

Compound 1 plasma concentrations in glioma patients (n=24) reachedsteady-state within 2 weeks of initiation of dosing and remainedconsistent over time. At steady-state, Compound 1 concentrations werebelow those predicted to pose a QT prolongation risk and above theconcentration predicted to reduce 2-HG levels by 90% (based onpreclinical data described above). Results are summarized in FIG. 37.

Plasma D-2HG was measured at baseline and during the course oftreatment. Baseline and maximum reduction (after a minimum of 28 days ofCompound 1 treatment) are shown for 15 disease-evaluable patients withpaired samples. Results are summarized in FIG. 38A and FIG. 38B. Medianduration of treatment at time of data cut was 3.7 months (range:0.9-9.4).

Compound 1 was measured in patient plasma and CSF. Results aresummarized in Table 30. Compound 1 human plasma protein binding was94.5% (5.5% unbound), and the unbound brain partition coefficient (Kpuu)for Compound 1 in humans was 0.54. This confirms that Compound 1 isbrain penetrant when administered at a clinically relevant dose.Compound 1 CSF concentration is predicted to be at the IC75 for 2-HGreduction.

TABLE 30 Compound 1 Compound 1 Compound 1 Brain Partition ObservedUnbound Coefficienct, Cycle/Day Time Date Matrix Conc, ng/mL Conc, ng/mLKp_(uu) C3D1 Pre Mar. 8, 2019 Plasma 1070 58.9 0.54 C3D7 — Mar. 14, 2019CSF 31.8 31.8 —

Compound 1 at 150 mg BID demonstrates acceptable safety profile inpatients with relapsed/refractory IDH1-mutated glioma. Steady-stateCompound 1 plasma concentrations were above preclinical minimumeffective concentration and below concentrations predicted to pose a QTprolongation risk in non-human primates. CNS penetration wasdemonstrated by CSF exposures and disease control, thus confirmingpreclinical experiments (e.g., as described herein). Nine of 15 patientswith glioma demonstrated a reduction of 2-HG at steady-state in plasma;however, 2-HG concentrations in plasma may not provide an accurateestimation of 2-HG reduction in tumor. Efficacy results suggest thatCompound 1 monotherapy shows positive clinical activity and diseasecontrol in a population with enhanced relapsed/refractory IDH1-mutatedglioma.

As of 31 Oct. 2019, 29 pts with R/R mIDH1 glioma were treated withCompound 1 as SA (n=24) or CO (n=5). The median age was 45 yrs (range:23-64) & 62% were male. WHO Glioma Grade (Gr) at study entry was: II(17%), III (52%) & IV (31%). Median number of prior treatments was 2(1-5); 86% had received prior temozolomide. mIDH1 status was locallydetermined (IHC, NGS or PCR): R132H (86%), R132L (7%), R132C (3.5%) &unspecified (3.5%). The median duration of Compound 1 treatment for SA &CO was 4.8 (1-11.4) & 1 (0.2-2.3) months, respectively. Fifteen ptsdiscontinued (disease progression [n=12], AE [n=1], withdrew consent[n=1], other [n=1]). For SA, the most common (>25%) TEAEs (all grades,regardless of attribution) were: fatigue (50%), nausea (50%), diarrhea(33%), ALT increase (29%) & headache (29%). For CO, TEAEs that occurredin ≥2 pts were: nausea (n=4), fatigue (n=2), neutropenia (n=2), ALTincrease (n=2) & AST increase (n=2). There were 2 protocol defined DLTsin the CO cohort, 1 pt with Gr 4 ALT, Gr 3 AST & Gr 3 GGT elevations & 1pt with Gr 3 ALT elevation. No pts experienced a TEAE of QTcFprolongation. SA best responses are shown in Table 31; CO pts are tooearly for response assessment. The median PFS for SA was 8.3 months.Twenty (87%) and 11 (48%) pts were alive and progression-free at 6 & 12months, respectively.

SA Compound 1 at 150 mg BID demonstrates acceptable safety andtolerability with preliminary clinical activity in glioma pts.Evaluation of CO is ongoing.

TABLE 31 Investigator Assessed Independent Central Best Response per SAVolumetric Assessment, n SA RANO, n (%) (N = 23)* (%) (N = 22) CR 0 ≥50%decrease 1 (5) PR 1 (4) >25% decrease but <50%  3 (14) decrease SD 10(43) ≤25% decrease and ≤25%  6 (27) increase PD 12 (52) >25% increase 12(55) *1 pt not evaluable

As of 2020-03-31, 44 patients with R/R mIDH1 glioma were treated withCompound 1. Baseline demographics and disease characteristics aresummarized in Table 32.

TABLE 32 Compound^(a) Compound 1 + Characteristic (N = 26) AZA (N = 6)Age, Median (range), Years    45 (23-64)  43 (29-49) Male, n (%) 17 (65)4 (67) ECOG PS, n 0 35 33  1 50 67  2 12 — Time since initial diagnosis,   6 (1-19)  9 (3-27) median (range), years Tumor histology, n (%)Anaplastic Astrocytoma 11 (42) — Oligodendroglioma  4 (15) 4 (67)Glioblastoma  8 (31) 1 (17) Anaplastic Oligodendroglioma 2 (8) 1 (17)Diffuse Astrocytoma 1 (4) — Tumor grade, n II  4 (15) 1 (17) III 13 (50)4 (67) IV  8 (31) 1 (17) Unknown 1 (4) — Tumor type, n (%) Enhancing 23(88) 5 (83) Non-enhancing  3 (12) 1 (17) R132X Mutation, n R132H 22  4R132L 2 — R132C 1 — R132G 1 — Other — 1 Unknown — 1 Prior regimens,median (range)  2 (1-5)  3 (1-4) ≥3 prior regimens, n 10 (38) 3 (50)Prior TMZ, n 23 (88) 5 (83) Prior radiation, n  26 (100)  6 (100)

Patient dispositions are summarized in Table 33.

TABLE 33 Compound 1 Compound 1 + AZA Characteristic (N = 26) (N = 6)Treatment ongoing, n (%) 10 (38)  1 (17)^(a) Treatment discontinued, n(%) Disease progression 13 (50) 4 (67) Adverse event 2 (8) 1 (17)Withdrew consent 1 (4) — ^(a)Patient continuing on monotherapy at datacutoff.

FIG. 39 shows Compound 1 plasma concentration levels. Consistent plasmaconcentrations at levels predicted to safely provide benefit wereachieved and maintained over treatment duration. Co-administration withAZA did not alter pharmacokinetics of Compound 1.

Table 34 summarizes TEAEs (≥15%) reported. (TEAE cutoff applied tomonotherapy population, N=26.) 6 (23%) monotherapy and 3 (50%)combination patients experienced ≥Grade 3 LFT abnormality. In twopatients, this led to treatment discontinuation (1 monotherapy; 1combination). Two DLTs (≥Grade 3 transaminase elevations) were observedfor combination treatment, which met stopping criteria.

TABLE 34 Compound 1 (N = 26) Compound 1 + AZA (N = 6) Any Grade AnyGrade TEAE, n (%) Grade 3/4 Grade 3/4 Nausea 14 (54)  1 (4) 4 (67) —Fatigue 13 (50)  — 2 (33) — ALT increased 8 (31)  3 (12) 5 (83) 3 (50)Diarrhea 8 (31) — 1 (17) — Headache 8 (31) 1 (4) 1 (17) — Constipation 7(27) — 2 (33) — Fall 7 (27) — — — AST increased 9 (28)  4 (13) 4 (67) 1(17) Dysgeusia 5 (19) — 1 (17) — Seizure 5 (19) — — Vomiting 5 (19) 1(4) 1 (17) — Dizziness 4 (15) — — Thrombocytopenia 4 (15) 1 (4) 2 (33) —

FIG. 40 summarizes duration on treatment with Compound 1 monotherapy.Disease control (PR+SD) was observed in 50% of patients, and 9 (38%)patients were stable for greater than 4 months. Median duration oftreatment was 4.2 months (range: 0.03 to 15.9). In enhancing patients,median duration of treatment was 3.7 months (range: 0.03 to 15.9).Median time to first response was 1.9 months. Median duration ofresponse was 10.1 months.

Investigator-assessed best overall response per RANO is summarized inTable 35A. FIG. 41 shows % change from baseline in investigatorassessment per RANO.

TABLE 35A Investigator-Assessed Response per RANO, n (%) Compound 1 (n =24)^(a) PR 1 (4) SD 11 (46) PD 12 (50) ^(a)Response-evaluable analysisset; 2 patients non-evaluable.

Independent central volumetric assessment of tumor burden (BICR) issummarized in Table 35B. FIG. 42 shows % change from baseline forcentral volumetric assessment (BICR).

TABLE 35B Independent Central Volumetric Assessment, n (%) Compound 1 (n= 22)^(a) ≥50% decrease  4 (18) >25% decrease but <50% decrease 1 (5)≤25% decrease and ≤25% increase  7 (32) >25% increase 10 (45)^(a)Response-evaluable analysis set; 2 patients non-evaluable; 2patients had no data at data cutoff.

A case study of a 50 year old female patient diagnosed with mIDH (R132H)glioblastoma follows. The patient was diagnosed in 2014 and underwenttreatment, including gross total resection, chemoradiation andtemozolomide. The patient enrolled in a Compound 1 clinical trial inMarch 2019, where the patient was treated with Compound 1 150 mg BID.After 15 cycles, the patient remains on treatment, off steroids, and isclinically stable. FIG. 43 shows a timeline of the patient's therapy,including exemplary brain scans throughout the patient's treatment withCompound 1.

Compound 1 was well tolerated as monotherapy in glioma patients.Compound 1 plasma concentrations were maintained over the treatmentduration at levels predicted to safely provide benefit. Clinicallyrelevant concentrations of Compound 1 were observed in the CSF,confirming CNS penetration observed in preclinical models. Compound 1demonstrated preliminary disease control rate of 50% in a heavilypretreated patients with predominantly enhancing recurrent mIDH1 glioma.Nine patients had SD for greater than 4 months. One patient achieved aPR per investigator assessment by RANO. Four patients achieved >50%tumor reduction by blinded independent central volumetric assessment(BICR).

Results—mIDH1 Solid Tumors

Isocitrate dehydrogenase 1 mutations (mIDH1) are present in a variety ofsolid tumors resulting in production and accumulation of(R)-2-hydroxyglutarate causing DNA hypermethylation and promotingtumorigenesis. Patients with advanced relapsed/refractory (R/R) mIDH1solid tumors received Compound 1 150 mg BID orally. Following a doseconfirmation cohort (Phase 1b), patients with intrahepaticcholangiocarcinoma (IHCC), chondrosarcoma (CS), or unspecified mIDH1solid tumors (Other) were enrolled in a Phase 2 efficacy evaluation(NCT: 03684811).

As of 31 Oct. 2019, 44 patients with relapsed or refractory mIDH1 solidtumors were treated with Compound 1. Diagnosis included: IHCC (n=26), CS(n=13), and Other (n=5). The median age was 58 years (range: 29-81) and43% were male. Median number of prior treatments was 2 (1-10). mIDH1status was locally determined (IHC, NGS or PCR): R132C (61%), R132G(7%), R132S (7%), R132H (2%), R132L (2%), Others (2%) & unspecified(18%). Fourteen patients discontinued treatment (disease progression[n=6; 3 IHCC, 2 CS, 1 Other], AE [n=4; 3 IHCC, 1 CS], PI decision [n=3;IHCC] & withdraw consent [n=1; IHCC]). Treatment emergent adverse events(all grades, regardless of attribution) that occurred in >15% of ptswere: nausea (43%), fatigue (25%), decreased appetite (22%), ASTincrease (18%), ALT increase (16%), and constipation (16%). Noprotocol-defined DLTs occurred. Best responses by tumor type are shownin Table 36.

Single agent Compound 1 at 150 mg BID demonstrates acceptable safety andtolerability with preliminary clinical activity in patients with R/RmIDH1 solid tumors.

TABLE 36 Investigator Assessed Best Response per RECIST, n IHCC CS OtherTumors* (%) (N = 26) (N = 13) (N = 5) CR/PR 0 0 0 SD  6 (23) 4 (31) 1(20) PD  3 (12) 2 (15) 1 (20) NE 1 (4) 1 (8)  0 Too early 16 (62) 6 (46)3 (60) *salivary tumor, lung adenocarcinoma, duodenal tumor (n = 1 foreach) and cancer of unknown primary (n = 2)

Example 13: Case Studies of Human Clinical Trial Testing of Compound 1

Patient X is 66 y/o female, diagnosed with AML who initially receivedinduction treatment with high dose cytarabine to which the patient wasrefractory. Subsequently, the patient enrolled in a clinical trialstudy, where she was treated with single agent (SA) Compound 1 150 mgBID and achieved a complete remission (CR) after one cycle of treatment(28 days). Patient continued treatment while in CR for 7 additionalcycles. Patient then relapsed and discontinued study treatment.

Patient Y is 62 y/o male, diagnosed with FLT3-positive secondary AML(secondary to MDS). Patient received intensive chemotherapy inductionwith cytarabine and daunorubicin in combination with midostaurin (FLT3inhibitor) but unfortunately was refractory. He enrolled in a clinicaltrial study, where he was treated with Compound 1 150 mg BID incombination with azacitidine for a total of 8 cycles (1 cycle=28 days).He achieved complete remission with IDH1 mutation clearance (CRm) bycycle 6 and discontinued study treatment after cycle 8 to undergo bonemarrow transplant (HSCT).

Patient Z is a 50 year old diagnosed with grade III IDH1m glioma(anaplastic astrocytoma) previously treated with chemotherapy andradiation according to the applicable standard of care. This patient wassubsequently enrolled on the clinical study treated with Compound 1 at150 mg twice daily (BID) each day. Following treatment with Compound 1for 2 cycles (each cycle=28 consecutive days receiving 150 mg Compound 1BID), by MRI, patient was determined by the investigator to haveexperienced a partial response by RANO criteria (>50% decrease in tumor,no new lesions, on stable dose corticosteroids, no progression ofmeasurable disease). After receiving 2 cycles of Compound 1 (150 mgBID), the patient remains on treatment with 150 mg BID Compound 1 perprotocol.

3 Patients received a Compound 1 at 100 mg once daily (QD) each day.Blood samples were collected every 28 days for measurement of plasmaconcentrations of Compound (single agent) Blood was collected at thefollowing times relative to Compound 1 administration:

-   -   Cycle 1 Day 1: predose, and postdose at 30 minutes, 1, 2, 4, and        8 hours    -   Cycle 1 Days 2, 8, 15, and 22: predose    -   Cycle 2 Day 1: predose, and postdose at 30 minutes, 1, 2, 4, and        8 hours    -   Cycle 2 Day 2: 24 hours after C2D1 dosing (±2 hours) for        patients in dose expansion    -   Cycle 2 Day 4: predose [72 hours after C2D1 dosing (±4 hours)]        for patients in dose expansion only    -   Cycle 2 Day 15: predose    -   Cycle 3 and Beyond: Predose on Day 1 of every cycle

The observed C_(min) associated with this case study can be found inFIG. 14.

Example 14: Diagnostic for Identifying AML Patients Having a SusceptiblemIDH1 Mutation

Abbott REALTIME IDH1 is a commercially available, FDA-Approved in vitropolymerase chain reaction (PCR) assay for the qualitative detection ofsingle nucleotide variants (SNVs) coding five IDH1 R132 mutations(R132C, R132H, R132G, R132S, and R132L) in DNA extracted from humanblood (EDTA) or bone marrow (EDTA). PMA Applicant: Abbott MolecularInc., 1300 E. Touhy Avenue, Des Plaines, Ill. 60018; FDA Approval Date:Jul. 20, 2018). Abbott RealTime IDH1 is for use with the Abbott m2000rtSystem. It will be appreciated that further details on using IDH1 Assayof this Example are available in product literature and instructionmanuals accompanying the assay and/or the real-time PCR system.

The Abbott RealTime IDH1 is indicated as an aid in identifying acutemyeloid leukemia (AML) patients with an isocitrate dehydrogenase-1(IDH1) mutation for treatment with an FDA-Approved mIDH1 inhibitor. Thistest is for prescription use only. The Abbott RealTime IDH1 detectssingle nucleotide variants (SNVs) coding five IDH1 mutations (R132C,R132H, R132G, R132S, and R132L) by using PCR technology with homogeneousreal-time fluorescence detection. The assay uses human blood or bonemarrow aspirate specimens and reports a qualitative result. The tablebelow lists the IDH1 mutations detected by the Abbott RealTime IDH1assay.

TABLE 37 Codon IDH1 Mutation SNV R132 R132C TGT R132H CAT R132G GGTR132S AGT R132L CTTBiological Principles of the Procedure

The IDH1 Assay of this Example consists of two kits:

-   -   IDH1 amplification reagent kit    -   IDH1 control kit

Specimens for the IDH1 Assay of this Example are processed manuallyusing reagents (e.g., lysis buffer containing guanidine isothiocyanate,magnetic microparticles, wash buffers, and/or elution buffer) to isolateand purify sample DNA. The amplification reagents are combined into twoamplification master mixes. The purified DNA sample is combined with themaster mixes in a 96-well optical reaction plate, and the plate istransferred to a real-time PCR instrument for amplification anddetection of IDH1 mutations. The specimen result is automaticallyreported on a real-time PCR workstation at run completion. Assaycontrols are included within each run and are processed through DNAextraction, amplification, and detection steps of the assay to assessrun validity.

Software parameters specific to the IDH1 Assay of this Example arecontained in an assay application specification file, which is loadedonto a real-time PCR instrument by using a CD-ROM disk.

DNA Extraction

The purpose of DNA extraction is to isolate and purify genomic DNA fromEDTA preserved blood or bone marrow aspirate specimens to make itaccessible for amplification and to remove potential inhibitors ofamplification. This process is accomplished by using magnetic particletechnology to isolate and purify DNA. During the DNA extractionprocedure, cells are lysed at an elevated temperature in a lysis buffercontaining guanidine isothiocyanate. DNA is captured on magneticmicroparticles, and inhibitors are removed by performing a series ofwashes with wash buffers. The bound DNA is eluted from themicroparticles with elution buffer and is ready for PCR amplification.

Reagent Preparation and Reaction Plate Assembly

IDH1 oligonucleotide reagents (Oligonucleotide Reagent 1 andOligonucleotide Reagent 2) are each manually combined with a DNApolymerase and activation reagent to create 2 unique master mixes. Thesemaster mixes are added to 2 separate wells of a 96-well optical reactionplate along with aliquots of the extracted DNA sample. After manualapplication of an optical adhesive cover, the plate is transferred to areal-time PCR instrument.

Amplification/Detection

Each master mix is designed to amplify and detect 2 or 3 IDH1 amino acidmutations (codon with mutant nucleotide underlined). Oligonucleotide 1master mix amplifies and detects R132C (TGT) and R132H (CAT).Oligonucleotide 2 master mix amplifies and detects R132G (GGT), R132S(AGT), and R132L (CTT). Refer to Table 38. In addition, both mastermixes are designed to amplify and detect a region of the IDH1 geneoutside of codon 132, which serves as an endogenous internal control(IC).

TABLE 38 IDH Mutation Detected by Each Master Mix Master Mix IDH1Mutation SNV Oligonucleotide 1 R132C TGT R132H CAT Oligonucleotide 2R132G GGT R132S AGT R132L CTT

During the amplification reaction on a real-time PCR instrument, thetarget DNA is amplified by DNA polymerase in the presence of primers,deoxyribonucleoside triphosphates (dNTPs), and magnesium chloride(MgCl2). The DNA polymerase used in the assay is a thermophilic enzymethat has been chemically modified, rendering it inactive (e.g., inactiveat ambient temperature).

During the amplification reaction of the IDH1 Assay of this Example, DNApolymerase is first activated at a high temperature. During eachsubsequent round of thermal cycling, a high temperature is used to meltdouble-stranded DNA strands, followed by a low temperature where primersanneal to their respective targets and are extended to generatedouble-stranded DNA products. Exponential amplification of the productsis achieved through repeated cycling between high and low temperatures.Amplification of IDH1 mutation and IC targets takes place simultaneouslyin the same PCR well.

IDH1 products are detected during the annealing/extension step bymeasuring the real-time fluorescence signals of the IDH1 mutation andIC-specific probes, respectively. The IDH1 mutation and IC-specificprobes are labeled with different fluorophores, allowing their signalsto be distinguishable in a single PCR well.

Assay Protocol

The IDH1 Assay protocol includes the following steps:

A. Manual preparation (i.e., DNA extraction) of samples (specimens andcontrols).

B. PCR assay setup using the sample eluates and an IDH1 amplificationreagent kit.

C. Amplification/detection on a real-time PCR instrument.

Assay Results

For each patient sample, 2 PCR reactions are evaluated. The IDH1 Assayof this Example is a qualitative assay for which specimeninterpretations are reported as “Mutation Detected” or “Not Detected.”For specimens with interpretations of “Mutation Detected”, the identityof the IDH1 mutation detected is reported.

Prevention of Nucleic Acid Contamination

The possibility of nucleic acid contamination is minimized because:

-   -   IDH1 Assay of this Example performs amplification and        fluorescence detection in a sealed 96-well optical reaction        plate.    -   Detection is carried out automatically without the need to open        the 96-well optical reaction plate.    -   Aerosol barrier pipette tips are used for all pipetting. The        pipette tips are discarded after use.    -   Separate dedicated areas are used to perform IDH1 Assay of this        Example.

We claim:
 1. A method of treating a patient diagnosed with a glioma characterized by an IDH1 mutation, the method comprising orally administering to the patient in need thereof a pharmaceutical composition comprising a total of 150 mg of olutasidenib twice per day (BID).
 2. The method of claim 1, wherein the olutasidenib is administered as a single agent.
 3. The method of claim 1, wherein the glioma is characterized by an R132 IDH1 mutation.
 4. The method of claim 3, wherein the R132 IDH1 mutation is selected from R132C, R132H, R132G, R132S, and R132L.
 5. The method of claim 1, wherein the glioma is relapsed/refractory mIDH1 glioma.
 6. The method of claim 1, wherein the patient has previously received temozoloide to treat a mIDH1 glioma prior to administration of the olutasidenib to the patient.
 7. The method of claim 1, wherein the olutasidenib is administered to the patient in need thereof in a tablet or capsule oral unit dosage form on consecutive days throughout a course of treatment of at least 15 consecutive days.
 8. A method of treating a patient diagnosed with a glioma having a susceptible IDH1 mutation comprising orally administering 150 mg of olutasidenib twice per day (BID) to the patient in need thereof.
 9. The method of claim 8, wherein the patient is diagnosed with a WHO Grade II or III glioma.
 10. The method of claim 8, wherein the patient is diagnosed with WHO Grade IV glioma.
 11. The method of claim 8, wherein the IDH1 mutation is a R132X mutation.
 12. The method of claim 11, wherein the IDH1 mutation is selected from the group consisting of R132C, R132G, R132S, R132H and R132L.
 13. The method of claim 8, wherein the glioma is a histologically or cytologically-confirmed IDH1 R132X gene-mutated advanced solid tumor.
 14. The method of claim 8, wherein the glioma is histologically or cytologically confirmed IDH1 gene-mutated advanced glioma, and a diagnosis of glioblastoma multiforme with confirmed IDH1 gene-mutated disease with first or second recurrence.
 15. The method of claim 8, wherein the patient is treated by administering the olutasidenib to the patient for at least 2 weeks.
 16. The method of claim 13, wherein the patient is treated by administering the olutasidenib for 0.9-9.4 months.
 17. The method of claim 8, wherein the patient is at least 18 years of age with a documented IDH1 gene-mutated malignancy based on an FDA approved test.
 18. The method of claim 17, wherein the patient meets one or more of the following inclusion criteria prior to treatment: a. recovered to ≤Grade 2 or baseline toxicity (except alopecia) from prior therapy (per CTCAE v 4.03); b. Eastern Cooperative Oncology Group (ECOG) performance status 0-2; c. adequate bone marrow function demonstrated by one or more of the following: absolute neutrophil count (ANC) ≥1.5×109/L without any growth factors in prior 7 days and Hemoglobin ≥8.0 g/dL (with or without transfusion support); platelet count ≥75×109/L (with or without transfusion support); and platelet count ≥100×109/L (with or without transfusion support)); and d. adequate hepatic function demonstrated by one or more of the following aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamic pyruvate transaminase [SGPT])≤2.5× institutional upper limit of normal (ULN), or for patients with suspected malignancy related elevations, <5×ULN; and Total bilirubin ≤1.5×ULN, or for patients with suspected malignancy related elevation <3× institutional upper limit of normal); and e. adequate renal function demonstrated by creatinine clearance per Cockcroft-Gault equation of ≥60 mL/min).
 19. A method of treating an adult patient diagnosed with a glioma having a susceptible IDH1 mutation comprising orally administering 150 mg of olutasidenib twice per day (BID) to the patient in need thereof. 